HIV and cardiovascular disease: managing high blood pressure
HIV is associated with an increased risk of cardiovascular disease (CVD, or heart disease). The exact reasons for this aren’t known for certain. However, it’s thought that a number of factors are important, including traditional CVD risk factors, the inflammation caused by untreated HIV infection, and the side-effects of some anti-HIV drugs.
High blood pressure (sometimes called hypertension) is one of those traditional risk factors for CVD, and is commonly found in people with HIV. A study from Switzerland has found that treating high blood pressure in people with HIV brought health benefits.
The researchers found that treatment for high blood pressure was successful in reducing blood pressure in people with HIV, which then reduced the risk that they would experience more serious cardiovascular problems, such as a heart attack or stroke.
The study found that people who were considered at high risk of CVD (for example, if they had kidney disease or diabetes, or if they had already had a stroke or heart attack) were likely to be treated for high blood pressure. However, researchers also found that people who had high blood pressure but didn’t seem to have other risk factors for CVD were less likely to be offered treatment for high blood pressure, even if it had been high for some time.
The researchers suggest that doctors should make sure they treat high blood pressure in people with HIV, bearing in mind that people with HIV seem to be at higher risk of cardiovascular disease.
For more news and features on cardiovascular disease, visit the topics pages of our website.
Health monitoring: CD4 cell counts
CD4 cells are white blood cells that organise your immune system’s response to infections. Your CD4 cell count is the measurement of the number of blood cells in a cubic millimetre of blood (a very small blood sample).
Having your CD4 cell count monitored regularly is a key part of checking the health of your immune system when you have HIV. People with HIV will usually have their CD4 cell count measured at their regular clinic appointments, which may happen every three to six months, depending on their health and whether they are on HIV treatment.
The study showed that if people had an undetectable viral load and a CD4 cell count over 300, their CD4 cell count was unlikely to fall to a level putting them at risk of developing opportunistic infections.
The researchers point out that annual monitoring could have benefits for both patients and health systems. They suggest that more frequent monitoring can cause anxiety for people with HIV. Doing fewer CD4 cell counts would also allow considerable cost savings.
Currently, in the UK, you are likely to have your CD4 count monitored every three to six months if you have a relatively high count, have no symptoms and are not on HIV treatment. Your doctor may suggest more frequent counts as your CD4 count nears 350, the threshold for starting treatment, if you develop HIV-related symptoms, or if the decline in CD4 cells seems to be speeding up. Once you are stable on treatment, you will have your CD4 count checked every three to six months.
It’s important to talk to your HIV doctor or another health professional familiar with your medical history before making any decisions about your regular health monitoring.
You can find out more about CD4 cell counts and other health monitoring in the UK in NAM’s booklet CD4, viral load & other tests.
HIV treatment and the liver
Having a healthy liver is important for everyone, as the liver plays an important role in processing substances in the body. For people with HIV, the liver is also vital for processing drugs used in HIV treatment.
Liver disease is a key cause of illness and death for people with HIV, but this is mostly linked to co-infection with hepatitis B or hepatitis C. However, sometimes liver problems are related to other causes, including the effect of some anti-HIV drugs.
The D:A:D study has involved large numbers of people in different countries since 1999. In this part of the study, which excluded people co-infected with hepatitis, only 12 people (0.05% of all deaths) died from liver disease.
Of these 12 deaths, seven were found to be linked to heavy use of alcohol. Only five deaths out of 1059 were linked to HIV treatment and four of these were associated with the use of older anti-HIV drugs, no longer routinely prescribed in the UK.
The researchers believe the study results show long-term treatment with current anti-HIV drugs is unlikely to cause liver damage. But they emphasise that it is important that HIV care includes regular monitoring of liver function.
You can find out more about liver function tests and regular HIV monitoring in NAM’s booklet CD4, viral load & other tests. More information on hepatitis is available on our topics pages.
Editors' picks from other sources
BHIVA and EAGA position statement on the use of antiretroviral therapy to reduce HIV transmission: January 2013
from Department of Health
The UK Department of Health, in collaboration with the Expert Advisory Group on AIDS and the British HIV Association, has issued a definitive statement on the potential of antiretroviral therapy to reduce HIV infectiousness and transmission. It says that the risk of transmission from a person with a fully-suppressed viral load in the absence of STIs is "extremely low" and advises physicians to discuss this with all patients.
A guide to clinical trials for people with hepatitis C
from Treatment Action Group
There are many new hepatitis C drugs being studied in clinical trials. People with hepatitis C have many options to choose from. Whether you have hepatitis C or another medical condition, deciding to participate in a clinical trial can be complicated. Having more information can help you decide whether or not to participate in a clinical trial, and which trial, or trials, may be right for you.
Generics could cut costs of HIV treatment
from MedPage Today
The US could save nearly $1 billion in the first year that generic anti-HIV drugs become available to American patients, researchers reported. The savings, however, would come at the cost of slightly lower efficacy.
HIV treatment during primary infection raises CD4s – and further questions
from AIDSMeds
Two new studies, each published in The New England Journal of Medicine, suggest that treating HIV with antiretrovirals (ARVs) within four to six months after infection helps raise CD4 counts, but neither study was able to make an overwhelming argument for starting therapy so early.