Highly active antiretroviral therapy (HAART), in addition to traditional vascular risk factors, may affect coronary heart disease (CHD) risk in individuals with human immunodeficiency virus (HIV) infection.
Among HIV-infected (931 men and 1455 women) and HIV-uninfected (1099 men and 576 women) adults, the predicted risk of CHD was estimated on the basis of age, sex, lipid and blood pressure levels, the presence of diabetes, and smoking status.
Among HIV-infected men, 2% had moderate predicted risk of CHD (10-year CHD risk, 15%-25%), and 17% had high predicted risk (10-year CHD risk of > or = 25% or diabetes). Among HIV-infected women, 2% had moderate predicted CHD risk, and 12% had high predicted CHD risk. Compared with users of protease inhibitor-based HAART, the adjusted odds ratio (OR) for moderate-to-high risk of CHD was significantly lower among HAART-naive individuals (OR, 0.57; 95% confidence interval [CI], 0.36-0.89). Users of HAART that was not protease inhibitor based (OR, 0.74; 95% CI, 0.53-1.01) and former HAART users (OR, 0.68; 95% CI, 0.46-1.03) were also less likely than users of protease inhibitor-based HAART to have moderate-to-high CHD risk, although 95% CIs overlapped the null. Low income was associated with increased likelihood of moderate-to-high CHD risk (for annual income < $10,000 vs. > $40,000: OR, 2.32; 95% CI, 1.51-3.56 ). Elevated body mass index (calculated as weight in kilograms divided by the square of height in meters) predicted increased likelihood of moderate-to-high CHD risk (for BMI of 18.5-24.9 vs. BMI of 25-30: OR, 1.41 [95% CI, 1.03-1.93]; for BMI of 18.5-24.9 vs. BMI > or = 30: OR, 1.79 [95% CI, 1.25-2.56]).
Among HIV-infected adults, in addition to antiretroviral drug exposures, being overweight and having a low income level were associated with increased predicted CHD risk. This suggests a need to target HIV-infected men and women with these characteristics for vascular risk factor screening.
"Interestingly, studies have shown that the spectrum of non-ADM among HIV-infected individuals is similar to that of solid-organ transplant recipients, implying the effect on cancer immune surveillance. PLWHA have a higher prevalence of cardiovascular disease risk factors - smoking, elevated triglycerides and lower levels of high density lipoprotein cholesterol. In one study, HIV positive veterans had an increased risk of incident acute myocardial infarctions compared to uninfected veterans, although the metabolic complications are related to the risk factors with cardiovascular disease. "
[Show abstract][Hide abstract] ABSTRACT: The Texas Center for Health Disparities, a National Institute on Minority Health and Health Disparities Center of Excellence, presents an annual conference to discuss prevention, awareness education and ongoing research about health disparities both in Texas and among the national population. The 2013 Texas Conference on Health Disparities brought together experts, in research, patient care and community outreach, on the "Intersection of Smoking, Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and Cancer". Smoking, HIV/AIDS and cancer are three individual areas of public health concern, each with its own set of disparities and risk factors based on race, ethnicity, gender, geography and socio-economic status. Disparities among patient populations, in which these issues are found to be comorbid, provide valuable information on goals for patient care. The conference consisted of three sessions addressing "Comorbidities and Treatment", "Public Health Perspectives", and "Best Practices". This article summarizes the basic science, clinical correlates and public health data presented by the speakers.
Journal of Carcinogenesis 10/2013; 12:18. DOI:10.4103/1477-3163.119388
"Traditional risk factors that are strong contributors to the elevated risk of CVD, such as smoking, elevated BMI, and prehypertension, were highly prevalent in our cohort. The contribution of such risk factors to an increased risk of CVD in the HIV-infected population is well documented (Armah et al., 2012; Glass et al., 2006; Kaplan et al., 2007). Results of our study demonstrated that HIVinfected adults have a high prevalence of cigarette smoking, a major traditional risk factor for CVD. "
[Show abstract][Hide abstract] ABSTRACT: Cardiovascular disease (CVD) has emerged as a major cause of morbidity and mortality in HIV-infected adults. Research in noninfected populations has suggested that knowledge of CVD risk factors significantly influences perceptions of risk. This cross-sectional study describes CVD risk factor knowledge and risk perception in HIV-infected adults. We recruited 130 HIV-infected adults (mean age = 48 years, 62% male, 56% current smokers, mean years since HIV diagnosis, 14.7). The mean CVD risk factor knowledge score was fairly high. However, controlling for age, CVD risk factor knowledge was not predictive of perceived risk [F(1, 117) = 0.13, p > .05]. Estimated risk and perceived risk were weakly but significantly correlated; r (126) = .24, p = .01. HIV-infected adults are at increased risk for CVD. Despite having adequate risk-factor knowledge, CVD risk perception was inaccurate. Improving risk perception and developing CVD risk reduction interventions for this population are imperative.
The Journal of the Association of Nurses in AIDS Care: JANAC 09/2013; 25(1). DOI:10.1016/j.jana.2013.07.006 · 1.27 Impact Factor
"There is also evidence that in the HAART era, HIV patients are at an increased risk of coronary heart disease. Also notable is the fact that hypertension may occur in up to 41% of HIV positive patients who survive for longer than 40 years (Kaplan et al., 2007). Lin et al reported an increased morbidity and mortality amongst HIV positive patients undergoing abdominal aortic aneurysm reconstruction. "
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