Reducing cardiovascular risk with aspirin

Spanish researchers believe that as many as a third of people with HIV could benefit from daily treatment with aspirin to reduce their risk of cardiovascular disease.

Aspirin is already widely used to reduce the risk of illnesses such as heart disease and stroke in HIV-negative patients. The treatment is simple and involves taking a single tablet every day. The drug thins the blood and prevents the formation of clots that are a feature of some cardiovascular conditions.

Cardiovascular disease is now a major cause of illness in people with HIV. The number of patients with HIV at risk of such diseases is expected to increase even more as more people with HIV live into older age.

Updated guidance on the use of aspirin to prevent cardiovascular disease was recently published in the US. It supports the use of aspirin for men aged between 45 and 79 and women between the ages of 55 and 79 who have other risk factors for cardiovascular disease.

Spanish researchers looked at the records of 120 HIV-positive patients to see how it could be applied to patients with HIV. They calculated that, using the new US guidance, 31% of  all patients (and 40% of men) would be candidates for aspirin therapy.

However, only two people were currently taking this treatment.

The researchers believe that many people with HIV who have risk factors for cardiovascular disease would benefit from treatment with aspirin.

But although aspirin is a very widely used drug, it can have other effects. If you are thinking about using aspirin, you should talk to a member of your healthcare team first.

Symptoms can predict an increase in viral load

Both physical and psychological symptoms can predict viral load increases in people taking HIV treatment.

Symptoms such as worry, sadness and diarrhoea were especially associated with rebounds in viral load to detectable levels.

Earlier research had shown that depression is associated with HIV disease progression in people who are not taking treatment.

Researchers in London wanted to see if symptoms could show which patients who were taking HIV treatment and who had an undetectable viral load had an increased risk of a rebound in their viral load.

In 2005, 188 patients who were taking HIV treatment and who had an undetectable viral load completed a questionnaire asking if they had experienced a range of physical and psychological symptoms.

Many of the patients reported experiencing symptoms. Some of the more common ones were tiredness (25%), worry (25%), and problems sleeping (21%).

The researchers then monitored their patients for an average of two years to see if there was any association between symptoms and changes in viral load. They found that both physical and psychological symptoms were associated with an increased risk of viral load increasing to detectable levels.

Even after taking into account reported adherence, the researchers found that anxiety and depression predicted a sustained rebound in viral load.

The researchers believe that their findings could have implications for the type of care offered patients taking treatment.

They suggest that an assessment “of virologic failure risk that is based solely on laboratory results, treatment history and adherence may be missing an important dimension – information from the patient’s perspective”.

Hepatitis C co-infection and CD4 cell count

CD4 cell count increases in HIV-positive patients taking antiretroviral therapy are smaller if they have a detectable hepatitis C viral load.

Many people with HIV are co-infected with hepatitis C. The liver disease caused by hepatitis C is a major cause of illness and death in these co-infected patients.

It’s known that HIV can hasten hepatitis C disease progression. However, there’s contradictory information about the impact of hepatitis C on HIV disease progression.

Canadian researchers were concerned that some of the research looking at the association between hepatitis C and the pace of HIV disease may have been flawed. This is because people were defined as having hepatitis C if they had antibodies to the disease.

Some people spontaneously clear hepatitis C, but they still have antibodies to the infection. This means that earlier research was likely to have included patients in the hepatitis C group who were actually free of the infection but still had antibodies.

To try and overcome this issue, the researchers compared changes in CD4 cell counts in two groups of HIV-positive patients. One group of patients had cleared infection with hepatitis C; the other group had developed long-term hepatitis C infection, with ongoing replication of the virus.

Changes in CD4 cell count were monitored before and after these two groups started taking HIV treatment.

There was some evidence that the rate of CD4 cell count loss was faster amongst the patients with ongoing hepatitis C replication. These patients lost an average of 84 CD4 cells per year, compared to a loss of 44 cells for patients who had cleared their hepatitis C infection.

After the patients started treatment, increases in CD4 cell count were significantly lower for patients with chronic hepatitis C infection. What’s more, these patients continued to have reduced increases in their CD4 cell count over time.

The researchers believe that successful treatment for hepatitis C would have dual benefits for co-infected patients. It would reduce their risk of liver disease, and also improve their HIV-related prognosis.