People with HIV seldom die of AIDS-related opportunistic infections anymore. Thanks to modern medicine called highly active antiretroviral therapy, or HAART, many people diagnosed with HIV today can expect to live as long as someone who doesn’t have HIV.
However, like all people who grow old, cardiovascular risk increases with age. Not only that, but because HIV produces a heightened state of inflammation within the body, the risk of cardiovascular disease is even greater. One recent study showed that people with HIV have double the risk of heart attack than people without.
The problem is compounded by the fact that the lifesaving HAART medications raise cholesterol. Finally, other risks associated with heart disease, such as smoking, also are higher among HIV-infected communities.
But a large clinical trial is underway to prevent heart disease among people with HIV. The trial, called REPRIEVE, plans to enroll 6,500 people with HIV from the U.S. and around the world. So far, 2,600 participants have signed up.
The trial will test whether a medication called pitavastatin can prevent heart disease in people with HIV. Just as there is a pill to prevent HIV in people who are at risk for contracting it, called Truvada as PrEP, or pre-exposure prophylaxis, pitavastatin would be like a PrEP against heart disease for people with HIV.
Pitavastatin is already approved by the FDA. It is in the class of drugs known as statins, which not only lower cholesterol, but also have been known to reduce inflammation.
REPRIEVE needs women with HIV to enroll in the trial as well as men, and recently launched a recruitment campaign called “Follow Your Heart.” You can learn more about the campaign by clicking here. The REPRIEVE trial is enrolling at 100 sites all over the U.S., Canada, Brazil, and South Africa. You can find a site near you by clicking here.
HIV, Heart Disease Assumed to Be “Men’s Diseases”
In a recent article co-authored by Dr. Anthony Fauci, head of the National Institute of Allergies and Infectious Diseases (NIAID), and legendary actress, singer/songwriter Barbra Streisand, the pair dispel myths that HIV and heart disease both are “men’s diseases.”
“Heart disease and HIV lead the list of medical research fields long overdue for a substantial re-focus on women’s health,” they write. “Heart disease, originally thought to be a man’s disease, is actually the number one cause of death for women worldwide. Heart disease is often a quiet killer when it targets women. In women, heart attacks can cause nausea, backache, fatigue, or shortness of breath; the dramatic, crushing chest pain classically associated with heart attacks in men may not characterize the clinical picture in women.”
Because HIV originally ravaged the gay community in the early days of the epidemic, many people still think of it solely as a man’s disease. In fact, black women represent one of the groups most affected by HIV.
“In the United States, African-American women have double the risk of HIV infection as compared to the general population,” Fauci and Streisand write. “Despite this burden, gaps in knowledge regarding the appropriate antiretroviral treatment regimens for women infected with HIV still persist. While antiretroviral dosing is currently the same for men and women, sex-specific research may be able to optimize treatment plans for each sex.
“Heart disease and HIV converge in the most unfortunate way for women. The risk of heart disease triples for HIV-positive women, even for those receiving treatment, compared with their uninfected counterparts.”
Women Can Make History With this Trial
The REPRIEVE trial is funded by the National Institute of Health’s National Heart, Lung and Blood Institute with support from the National Institute of Allergy and Infectious Disease (NIAID), as well as from Kowa Pharmaceuticals and Gilead Sciences.
In a statement to Vital Updates by Dr. Markella Zanni, she explained that additional funding from the NIAID will be used to study sex-specific mechanisms of heart-related disease risk and risk reduction. “In this way, individuals participating in the main REPRIEVE trial are helping to contribute to new knowledge at the intersection of HIV heart health and women’s health.”
Previous studies already have shown that women with HIV have high levels of immune activation and inflammation, Zanni said. REPRIEVE investigators will try to learn more about whether these mechanisms “contribute uniquely to heart disease risk among women aging with HIV and how statin therapy may reduce heart disease risk through effects on these pathways. These objectives also involve studying how sex-specific factors – including levels of women’s sex hormones – contribute to heart disease risk and risk reduction in HIV.”
Traditionally, women have been underrepresented in HIV research, Zanni said. “Robust participation of women is considered to be essential to the success of the trial.”