HIV update - 30th October 2019

A round-up of the latest HIV news, for people living with HIV in the UK and beyond.

What is your heart age?

‘Heart age’ is a way you can understand your risk of a heart attack or stroke. Heart age is calculated based on well-known risk factors for heart disease (such as age, smoking, blood pressure, cholesterol and diabetes).

It is based on an estimate of your risk of a heart attack or stroke in the next five years compared with the risk of someone of the same age who does not have high cholesterol, high blood pressure or other risk factors. So, if you have a heart age of 52 years, this indicates that you have the same risk of having a heart attack or stroke in the next five years as someone 52 years of age.

Researchers have calculated the heart age of just over 3000 people living with HIV in the United States. They found that while the people in their study had an average real age of 49 years, the men’s average heart age was 12 years older (61 years) and the women’s average heart age was 13 years older (62 years).

The excess heart age estimates in this study are higher than those of the general population in the United States – an extra eight years for men and five years for women.

Heart age was greater than people’s real age by at least ten years for 53% of men and 59% of women living with HIV in the study.

The NHS website has an online tool to allow you to calculate your own heart age. It gives advice on how you can reduce your heart age and your risk of heart disease.

One thing to note is that these calculators are based on risk factors for heart disease in the general population. As having HIV can also raise the risk of heart attacks and strokes, it’s possible that the figures mentioned above are actually under-estimates of people’s heart age.

For more information, read NAM's page 'The heart'.

Chronic kidney disease

Chronic kidney disease is a health problem that affects a number of people living with HIV, especially as they get older. Because of genetic factors, you are at greater risk if a close family member has had kidney disease or if you are black or Asian. The two most important causes of kidney disease are diabetes and high blood pressure, both of which can be treated and prevented.

HIV itself may contribute to kidney disease. Individuals who have a low CD4 count, have a high viral load, or were diagnosed at a late stage are at greater risk of developing kidney disease. Some anti-HIV drugs can also contribute to kidney problems in a minority of people.

A new study shows that serious health problems often follow a diagnosis of chronic kidney disease. The study included almost 2500 people with HIV who had been diagnosed with chronic kidney disease in Europe, the United States or Australia.

Many people had risk factors for kidney disease which could potentially have been prevented or changed. A third were smokers, a fifth had high blood pressure, 59% had high cholesterol or triglycerides, one in six had diabetes, and a third either had a CD4 cell count below 350 or a viral load above 10,000.

In the first year after diagnosis with chronic kidney disease, 8% of people had a serious health problem. These included cancer, heart disease, AIDS-defining illnesses, or death.

In five years after diagnosis, this increased to 29%.

The risk factors mentioned above (especially having a low CD4 count, high viral load, diabetes or smoking) all made these serious health problems more likely.

So the researchers say that people who have both HIV and chronic kidney disease should get lots of support from their doctors, especially help to reduce those risk factors. For example, that might include support to take HIV treatment regularly, stop smoking, lose weight, exercise regularly, and eat a healthy diet.

For more information, read NAM's page 'Chronic kidney disease and HIV'.

Cognitive impairment

There has been a big fall in Swiss people with HIV reporting frequent memory loss, concentration difficulties and reasoning difficulties in recent years. Between 2013 and 2017, the proportion reporting one of these problems fell from 20% to 11%.

The researchers think this may be because more people are starting effective HIV treatment sooner. This helps prevent one form of cognitive impairment which occurs when HIV (or the response of the immune system to HIV) directly affects the brain and causes cognitive problems.

Compared to people without any problems, people with persistent cognitive impairment were more likely to have previously had a serious infection affecting the brain or spinal cord, to have less than perfect adherence to HIV treatment, or to have been diagnosed with depression.

The data come from over 8000 people living with HIV who completed questionnaires about symptoms and other health issues. Everyone completed several questionnaires between 2013 and 2017.

For more information, read NAM's page 'Cognitive impairment and HIV'.