How Do HIV and Heart Disease Relate?

Despite living longer thanks to improvements in HIV treatment, people with HIV nevertheless face heart disease and associated consequences more frequently than people without HIV infection. Cardiologists at Johns Hopkins University are researching the causes and consequences of the increased risk of heart disease among HIV-positive people as well as developing and evaluating new treatments for this condition. Regardless of other risk factors for coronary artery disease, Johns Hopkins researchers discovered that men with long-term HIV infections have a higher chance than men who are not infected of acquiring plaque in their coronary arteries. In order to determine if the plaque had calcified or not and to what extent, researchers assessed plaque and stenosis, a narrowing of blood vessels, in the cardiac arteries of HIV-positive patients. Compared to calcified plaques, no calcified and partially calcified plaques are more likely to cause the formation of a clot that restricts or prevents blood flow to the heart. They discovered that no calcified coronary artery plaque, which can be detected on CT angiography, was more common and widespread in males with HIV, indicating a higher risk for heart attacks. The findings indicate that it is critical to carry on with the research to alter the conventional risk factors for HIV-positive people. The diagnosis and management of cardiac disease in HIV-positive patients should advance along with HIV treatment. In this same group of males, researchers are presently examining predictors of plaque and stenosis advancement. Another Johns Hopkins study found that HIV-infected individuals without plaque in their coronary arteries responded very strangely to stress. This excessive stress response is a precursor to future unfavorable cardiovascular events like heart attacks and unexpected death and is comparable to persons with severe coronary artery disease. Thus, the cardiac arteries of HIV-infected individuals display aberrant responses linked with negative outcomes even before the formation of visible plaque. Even though HIV is undetectable in the blood, one explanation is that patients with HIV have elevated levels of immunological activation and inflammation. The health of the cardiac arteries as seen by MRI is being studied by Hopkins researchers in relation to novel biomarkers of inflammation and if reducing inflammation is beneficial. The effectiveness of frequently prescribed drugs like colchicine, which is used to treat gout, and more recent drugs like evolocumab, which is typically used to treat high cholesterol, are being studied. The effectiveness of frequently prescribed drugs like colchicine, which is used to treat gout, and more recent drugs like evolocumab, which is typically used to treat high cholesterol, are being studied.