Research linking heart attack risk to people with HIV just keeps getting more and more dire.
The latest paper, published Wednesday in JAMA Cardiology, shows that people with HIV have almost double the risk of heart attack than people who do not have the disease. This is because the disease causes a heightened state of inflammation in the body, even in people on the antiretroviral drugs that allow people with HIV to live long lives by keeping the virus from replicating to dangerous levels.
But therein lies the rub: Not only are people with HIV at greater risk for heart attack, now many of them are reaching their golden years, so their chances of having a heart attack have increased by way of aging, too. Unfortunately, a disproportionate number of people with HIV also smoke, further increasing their chances of having a heart attack.
The JAMA study used a very large sample of more than 11,000 people with HIV, mostly men. It showed heart attack risk was higher among black men and black women with HIV, those over 40, and those who were not virally suppressed, which usually can be achieved with today’s HIV medications.
The problem they found was that heart attack risk cannot be accurately predicted among people with HIV using today’s “algorithms,” which in medical terms essentially is a way to solve or predict a problem using certain data.
A clinical trial currently is underway to determine whether the use of statins in people with HIV can fend off heart attacks. It has become known as a “PrEP against heart disease.” PrEP is a medication that people who do not have HIV can now take once a day to prevent becoming infected.
In an interview with the website HIV Equal, Dr. Steven Grinspoon, a principal investigator for the statin study from Massachusetts General Hospital/Harvard Medical School, explained how the inflammation occurs.
“When HIV infects the body, it targets the lymphoid tissue in the gut, and the tissue becomes depleted,” HIV Equal reported. “’The gut then becomes leaky and full of bacterial-related cytokines, particularly those called lipopolysaccharides, and that sets off an inflammatory cascade,” Grinspoon said.
“Even with the most powerful ART medication available,” HIV Equal went on to report, “’It may not fully oppress the associated inflammation,’ Grinspoon said. ‘At a low level, it’s always there.’”
A study published in August showed that for people with HIV who are depressed, the risk of heart attack is higher still. And rates of depression, like smoking, are elevated among people with HIV, according to a Healthline News story.
As for smoking, “We know from a large surveillance project running here that the prevalence of smoking among people with HIV in care is about 42 percent,” Dr. John T. Brooks, an HIV specialist with the CDC, told Healthline News. “If you have HIV and smoke, you’re getting hit from both directions with this inflammatory problem.”