HIV and heart disease, two things we don’t necessarily think of as being intrinsically linked yet this is far from the truth. While in over the last 10 years, we have seen a decline life-threatening, opportunistic infections among treated HIV patients, this does not tell the whole story. In recent years clinicians have seen more and more instances of HIV related cardiovascular disease with it becoming the leading cause of death for patients with HIV (1).

Why is this the case? Scientists believe that the reason for patients with HIV having an increased risk of cardiovascular disease, with a HIV-positive person being twice as likely as a HIV-negative person to experience a heart attack or stroke (1), is due in part to the constant activation of the immune system. Although the mechanism behind this link is still being researched, it is suspected that due to the chronic activation of the immune system there is a surplus of inflamed blood vessels and clotting factors which both in turn function as major risk factors for serious cardiovascular events. This is seen event in medicated HIV patients where the levels of HIV are undetectable in the blood (2). This chronic inflammation is also linked to a build up of plaque in the arteries which is has also been linked to antiretroviral therapy, the current treatment of HIV, and many HIV-associated comorbidities such as drug abuse and opportunistic infections.

However there is hope, in 2015 the National Institute of Allergy and Infectious Disease and the National Heart, Lung and Blood Institute launched REPRIEVE (Randomised Trial to Prevent Vascular Events in HIV) which hopes to enrol a minimum of 6,500 HIV positive patients between the ages of 40 and 75 to see if a daily dose of pitavastatin can further reduce the risk of a cardiovascular event in people with HIV (3). This is the first major Phase 3 trial on this subject and will hopefully help further improve the quality of care provided as HIV transitions to chronic condition from the acute infection it once was.

To learn more about the work of REPRIEVE visit their website http://www.reprievetrial.org/

Bibliography

1. NIAID Now. REPRIEVE: A Large Trial for a Growing Problem amoung People with HIV. NIAD. [Online] May 29, 2019. [Cited: February 6, 2020.] https://www.niaid.nih.gov/news-events/reprieve-heart-disease-among-people-hiv.

2. John Hopkins Medicine. HIV and Heart Disease. John Hopkins Medicine. [Online] [Cited: February 6, 2020.] https://www.hopkinsmedicine.org/research/conditions/hiv-and-heart-disease.

3. NIAID Now. Happy Heart Month: What People Living with HIV Should Know. NIAID. [Online] February 14, 2018. [Cited: February 6, 2020.] https://www.niaid.nih.gov/news-events/happy-heart-month-what-people-living-hiv-should-know?fbclid=IwAR2Vrb-9jpgponyNpUxVtSvvRvfQPVI-Q5_o_LHBIri8-A8o8Ai37feIBFY.