HIV and cardiovascular disease

Abstract

HIV-related cardiovascular disease research is predominantly from Europe and North America. Of the estimated 37·9 million people living with HIV worldwide, 25·6 million live in sub-Saharan Africa. Although mechanisms for HIV-related cardiovascular disease might be the same in all people with HIV, the distribution of cardiovascular disease risk factors varies by geographical location. Sub-Saharan Africa has a younger population, higher prevalence of elevated blood pressure, lower smoking rates, and lower prevalence of elevated cholesterol than western Europe and North America. These variations mean that the profile of cardiovascular disease differs between low-income and high-income countries. Research in, implementation of, and advocacy for risk reduction of cardiovascular disease in the global context of HIV should account for differences in the distribution of traditional cardiovascular disease risk factors (eg, hypertension, smoking), consider non-traditional cardiovascular disease risk factors (eg, access to antiretroviral therapy with more benign cardiovascular disease side effect profiles, indoor air pollution), and encourage the inclusion of relevant risk reduction approaches for cardiovascular disease in HIV-care guidelines. Future research priorities include implementation science to scale up and expand integrated HIV and cardiovascular disease care models, which have shown promise in sub-Saharan Africa; HIV and cardiovascular disease epidemiology and mechanisms in women; and tobacco cessation for people living with HIV.

Figure 1:. Prevalence distribution of HIV and risk factors for cardiovascular disease

World maps showing increased HIV prevalence, age, raised blood pressure, raised blood cholesterol, raised fasting blood glucose, heavy episodic drinking, and tobacco smoking. Permission from WHO and the Institut National d’Etudes Démographiques. (A) Prevalence of HIV among adults aged 15–49, 2016 classified by WHO regions. Global prevalence of HIV: 0·8 (average 0·7–0·9). Numbers in brackets show global prevalence of HIV on average. (B) Median age (years), 2017. (C) Prevalence of raised blood pressure (systolic blood pressure ≥140 mm Hg; diastolic blood pressure ≥90 mm Hg), ages over 18 years, 2015. Age-standardised estimate for both sexes. (D) Prevalence of raised blood cholesterol (≥5·0 mmol/L), ages over 25 years, 2008. Age-standardised estimate for both sexes. (E) Prevalence of raised fasting blood glucose (≥7·0 mmol/L or on medication for raised blood glucose), ages over 18 years, 2014. Age-standardised estimate for both sexes. (F) Prevalence of heavy episodic drinking among both sexes, ages over 15 years and older, 2016. (G) Prevalence of tobacco smoking among people aged 15 years and older, 2016. Age-standardised estimate.

Figure 2:

Mechanisms of HIV-associated cardiovascular disease

Figure 3:. Intervention points to reduce HIV-associated cardiovascular disease risk stratified by income status

ART=antiretroviral therapy.