HIV and heart problems

People with untreated HIV infection have an increased risk of heart failure, according to new US research.

The study involved just under 9000 people, 28% of whom were HIV-positive.

People with HIV were almost twice as likely to experience heart failure as HIV-negative patients. Heart failure is a gradual weakening of the heart that leads to increasing breathlessness and weakness, and requires medication or surgery if it becomes more severe.

HIV was the second strongest risk factor for heart failure, after high blood pressure. Indeed, HIV had a stronger association with heart failure than traditional risk factors such as smoking and older age.

However, people with an undetectable viral load had a much lower risk of heart failure than individuals whose viral load was detectable.

The inflammation caused by HIV has been linked in other research to an increased risk of cardiovascular disease.

This is one of the reasons why current UK guidelines recommend starting HIV treatment when your CD4 cell count is around 350. Patients with traditional risk factors for heart disease are especially encouraged to start treatment at this time.

The researchers also think some of the infections that are common in patients with HIV may be contributing to the inflammation that increases the risk of heart failure.

Nevertheless, the doctors who conducted the study stressed the importance of addressing modifiable risk factors for cardiovascular disease in routine HIV care.

These include smoking, blood pressure, weight, levels of blood fats, and exercise.

Separate research has found that the volume of fat around the heart is linked to hardening of the arteries, a traditional risk factor for cardiovascular disease.

The study involved over 800 patients who had experience of HIV treatment.

CT scans (computerised tomography) were used to measure the volume of fat around the heart.

Most of the patients were men and they had been living with HIV for an average of 15 years.

Many – 61% – had lipodystrophy, a type of body fat changes that are a side-effect of some older anti-HIV drugs.

Higher volumes of fat around the heart were linked with a marker of hardening of the arteries.

Risk factors included a lower CD4 cell count and lipodystrophy that involved fat gain.

Vitamin D

Low levels of vitamin D are associated with an increased risk of disease progression for patients with HIV.

Researchers in Europe, Argentina and Israel found a strong association between low levels of the vitamin and an increased risk of both death from any cause and the development of an AIDS-defining condition.

A number of other studies have already shown that vitamin D levels are often low in HIV-positive patients. It’s already known that deficient levels of the vitamin are associated with an increased risk of a number of serious illnesses in HIV-negative patients.

The latest research involved 1985 patients, and 82% were taking HIV treatment.

Only 11% of patients had levels of vitamin D that are generally considered sufficient.

“The present results confirm that vitamin D insufficiency or deficiency is frequent in HIV-infected persons,” comment the investigators.

Factors associated with very low levels of vitamin D included black race, injecting drug use, heterosexual HIV risk, and older age.

Rates of disease progression were much higher among patients with the lowest levels of the vitamin.

Over five years, 10% of these people developed AIDS compared to 6% of individuals with moderate vitamin D levels and 5% of people with high levels of the vitamin.

Mortality rates also varied according to vitamin D level, and were highest for those with the lowest levels.

“A very low [vitamin] D level was associated with events, even in the case of virologically controlled HIV infection and immune restoration,” the authors emphasise.

Vitamin D can be easily monitored during routine HIV care; if necessary, taking supplements can boost levels.

HIV and hepatitis C treatment

A small study has shown that twice-weekly doses of pegylated interferon modestly improve the response rate to hepatitis C treatment in co-infected patients.

Liver disease caused by hepatitis C is now a leading cause of serious illness and death for people who are HIV-positive and co-infected with hepatitis C.

Treatment for hepatitis C is available and consists of weekly injections with pegylated interferon and daily oral doses of ribavirin. However, only a minority of patients with chronic co-infection respond to this treatment.

Suppression of hepatitis C viral load during the first few weeks of treatment predicts longer-term successful treatment outcomes. Researchers wanted to see if boosting levels of pegylated interferon during the first four weeks of therapy improved longer-term response rates.

Their study involved 19 patients. They were randomised to receive standard treatment, or the experimental dosing schedule.

Hepatitis C viral load was more likely to be suppressed to undetectable levels during the first few weeks of therapy among the patients who received additional doses of pegylated interferon.

Overall, 57% of patients who received the experimental treatment were cured of hepatitis C compared to 50% of individuals who received the standard therapy.

The provision of additional doses of the drug particularly boosted response rates in African Americans, who often respond poorly to hepatitis C therapy.