With the success of antiretroviral therapy (ART), people living with HIV (PLWH) now enjoy longer life expectancies than ever before. However, this increased lifespan has brought a new challenge: a significantly higher risk of early cardiovascular disease (CVD).

Research shows that HIV-positive individuals are 1.5 to 2 times more likely to develop heart disease at a younger age compared to HIV-negative individuals. This article explores the underlying causes, scientific findings, and most importantly, how to reduce that risk through prevention and lifestyle changes.

Why Does HIV Increase Heart Disease Risk?

Cardiovascular disease in HIV patients is multifactorial, meaning it’s influenced by a mix of biological, lifestyle, and treatment-related factors.

1. Chronic Inflammation & Immune Activation

Even with effective ART and undetectable viral load, HIV causes persistent low-grade inflammation in the body. This leads to:

• Damage to blood vessel linings (endothelium)
• Increased plaque formation
• Accelerated atherosclerosis (hardening of arteries)

2. Immune System Dysfunction

HIV affects CD4+ T-cells, weakening the immune system. This dysfunction can:

• Promote autoimmune reactions
• Make the body less effective at repairing vascular damage

3. Side Effects of Antiretroviral Therapy (ART)

Some older or specific ART drugs (especially protease inhibitors and abacavir) are associated with:

• Increased cholesterol and triglyceride levels
• Insulin resistance
• Elevated risk of metabolic syndrome

4. Higher Prevalence of Traditional Risk Factors in PLWH

People living with HIV often have a higher rate of:

• Smoking
• Diabetes
• Obesity
• Sedentary lifestyle
• Co-infections like Hepatitis B/C, which can indirectly impact cardiovascular health

5. HIV-Associated Lipodystrophy

This condition, caused by some ART medications, leads to abnormal fat distribution and metabolic changes, further increasing the risk of heart disease.

What Does the Research Say?

Several key studies have demonstrated the link between HIV and heart disease:

• The REPRIEVE Trial (NIH, ongoing) is investigating whether statins can prevent heart disease in HIV patients.
• A study published in JAMA Cardiology (2020) found that HIV-positive individuals had a 50–100% higher risk of heart attack than the general population.
• A 2023 report in The Lancet HIV showed increased arterial stiffness and vascular inflammation in young adults with HIV — even those on effective ART.

In short, heart disease now rivals opportunistic infections as a leading cause of morbidity in aging HIV patients.

Early Warning Signs & Screening

HIV patients often experience “silent” heart disease, where symptoms may not be obvious until major events like a heart attack or stroke occur. Regular screening is essential.

Doctors typically monitor:

• Blood pressure
• LDL/HDL cholesterol
• Blood sugar and insulin levels
• C-reactive protein (CRP) — marker of inflammation
• Carotid intima-media thickness (CIMT) — ultrasound measure of artery wall thickening

Prevention Strategies: How to Lower the Risk

Fortunately, many of the risks can be controlled with the right interventions.

1. Stick to Effective ART

• Modern ART regimens are safer and more heart-friendly than earlier generations.
• Staying virally suppressed reduces inflammation and immune activation.
• If you’re on older ART (e.g., abacavir, lopinavir), talk to your doctor about switching.

2. Adopt Heart-Healthy Habits

3. Control Blood Pressure & Cholesterol

• Use statins if needed — they not only lower cholesterol but also have anti-inflammatory benefits in HIV.
• REPRIEVE trial is evaluating long-term statin use in HIV for prevention even in low-risk patients.

4. Manage Diabetes and Insulin Resistance

• Monitor A1C and fasting glucose regularly.
• Adopt a low-glycemic index diet and stay active.

5. Address Mental Health & Stress

• Chronic stress and depression (common in HIV) can raise cortisol and BP.
• Practice mindfulness, therapy, and sleep hygiene.

Summary Table: HIV and Heart Disease

Final Thoughts

People living with HIV now live longer — but with longevity comes greater vulnerability to chronic illnesses like heart disease. The good news is that with early screening, modern ART, and healthy lifestyle choices, heart disease in HIV-positive individuals is largely preventable.

HIV-positive people are living longer than ever because of therapies that prevent the growth of the virus. But these patients deal with more heart troubles and barriers to treatment than other individuals, according to the American Heart Association (AHA).

A scientific statement published in June 2019 in the journal Circulation highlighted that three-quarters of people over the age of 45 who are living with HIV are experiencing significantly more heart attacks, heart failure, and strokes earlier in life compared with those who don’t have HIV.

“Chronic inflammation and immune activation [or response] appear to be the primary drivers of high heart disease risk in HIV,” says Matthew Feinstein, MD, chair of the writing group for the statement and assistant professor of medicine and preventive medicine at the Feinberg School of Medicine at Northwestern University in Chicago.

He stresses that HIV treatment is essential, not only for controlling the virus, but also for reducing chronic inflammation and problems with immune regulation.

“Several studies have now shown that worse HIV control is associated with higher risks for heart disease,” Dr. Feinstein told Everyday Health. “So the first and most important step in preventing heart disease in HIV is getting the HIV under control with the right medications prescribed by HIV specialists and primary care doctors.”

Addressing Common Heart Disease Factors

The statement authors also observed that people living with HIV more often had factors commonly associated with heart troubles, such as heavy alcohol use, substance abuse, mood and anxiety disorders, low levels of physical activity, and poor cardiorespiratory fitness.

About 4 out of 10 are smokers, according to a nationally representative sample of HIV patients.

Quitting tobacco use, eating a balanced diet (such as the DASH diet or Mediterranean diet), and staying physically active can help lower risk, notes Feinstein.

Sarah Samaan, MD, a cardiologist with Baylor Scott & White Legacy Heart Center in Plano, Texas, who was not an author on the statement, has seen many HIV patients benefit from statin drugs to lower cholesterol and medication to lower blood pressure.

“Since some HIV medications can raise the risk of side effects from other drugs, it’s important to discuss the options for treatment with a knowledgeable physician,” say Dr. Samaan. “A good pharmacist can also help to ensure that the drugs that are prescribed are safe and appropriate.”

Living Longer But With More Health Problems

In an accompanying patient perspective published by the American Heart Association, Jules Levin, the founder and executive director of the National AIDS Treatment Advocacy Project (NATAP), expressed his concerns about the high numbers of serious medical problems in older people with HIV compared with the general population.

According to NATAP, those with HIV over 60 years old have an average of three to seven health conditions in addition to being HIV-positive. Comorbidities include heart attacks, strokes, heart failure, kidney disease, frailty, and bone diseases. Also, many take 12 to 15 drugs daily.

“Most people don’t know that HIV is causing accelerated aging,” says Levin, who has been living with HIV for 35 years. “Within a few years of initial infection, the immune system senescence [deterioration with age] sets in right away. Once people with HIV get into their sixties, they really have a double hit — from aging and from the effects of HIV.”

This is why Levin urges HIV-positive individuals to be screened for cardiovascular troubles as well as bone density, kidney disease, and cognitive impairment.

The scientific statement recommends trying the American Heart Association–American College of Cardiology Atherosclerotic Disease Risk Calculator as one way for getting some idea of your heart disease risk.

Overcoming Barriers to Treatment

Both Feinstein and Levin spotlight the need for improving access to healthcare for people living with HIV. The statement authors pointed out that this population is often stigmatized, and federal and local authorities could make more effort to increase care options for these individuals. Many living with HIV are homebound and cognitively impaired to a degree where they have difficulties paying bills and making decisions.

“What’s most needed are support services and better care in the clinics,” says Levin. “We need to actively demand that federal and local officials address this problem.”

He urges people to contact NATAP to explore ways to take action.

A Call for Further Research

Feinstein and his coauthors based this scientific statement on large observational studies investigating HIV and heart disease.

“But we don’t yet have much in the way of large-scale randomized trial data for heart disease prevention and treatment in HIV,” he says. “Although we have a reasonable understanding of why plaque buildup in the arteries occurs in HIV, we do not have as clear of an understanding of why the heart muscle often becomes dysfunctional or why blood clotting may occur more commonly in HIV.”

The post HIV and Early Heart Disease: Risks, Causes, and Prevention appeared first on MyMedicPlus.

During the Focusing on Fertility panel at the 137th Angus Annual Meeting, Kent Weigel, professor and chair of the Department of Animal and Dairy Sciences at the University of Wisconsin-Madison; Tom Lawlor, executive director of research and development at the Holstein Association, USA; and Kelli Retallick, director of genetic and genomic programs for Angus Genetics, Inc., discussed the importance of improving reproductive function for the Angus breed and the cattle industry and the role that haplotypes play in bovine fertility.

Haplotypes are alleles that are inherited as a group from a single parent. Through genomic testing, haplotypes that affect many traits can now be identified. In 2011, the dairy industry identified haplotypes that negatively affect fertility by causing embryonic loss. Using this research, AGI and the American Angus Association® have been studying haplotypes that affect fertility in the Angus breed.

Kent Weigel

Weigel began the discussion by addressing the importance of fertility and how research over the last 20 years has focused on improving fertility for the profitability of the operation. He provided the background and basic terminology surrounding haplotypes and highlighted their value in improving fertility.

Weigel shared how VanRaden and others identified five haplotypes that affect fertility in three breeds of dairy cattle in 2011. Researchers found that genomic testing provides shortcuts to finding lethal mutations that affect embryonic viability. Because embryos that inherit two copies of a lethal fertility haplotype from its parents are not carried to term, it is all about finding haplotypes with missing homozygotes.

“You can use a haplotype test many, many years in advance and they can provide a faster, albeit imperfect, way to manage potentially lethal defects more proactively,” said Weigel, as he concluded his presentation.

Tom Lawlor

Lawlor followed Weigel in the panel discussion where he focused on research that he has conducted at Holstein Association USA since 2011. The Holstein breed was one of the first to adopt genomic testing and discover haplotypes.

“The goal with genomic testing at the Holstein Association is to test and move our breed forward—NOT test and punish our association,” said Lawlor.

Lawlor shared how the Holstein breed turned haplotypes that impact fertility into a new class of genetic defects. He went into detail about the differences between genetic conditions and haplotypes. Fertility haplotypes tend have unseen problems; they occur before birth, have less of a financial loss and are less accurate.

Lawlor also stated, “We don’t want to simply eliminate families with these haplotypes and lose out on the genetic advantage they offer the breed.”

To properly manage fertility haplotypes, Lawlor shared how the Holstein Association has improved its communication and offered mating tools to help breeders more easily avoid carrier-to-carrier matings.

Kelli Retallick

Retallick concluded the panel as she shared what the Association is doing regarding haplotypes that affect fertility in Angus cattle. She emphasized how the Angus breed should learn from the dairy industry.

“When looking to the dairy industry, we learn that the Association needs an even larger database. These haplotypes affecting fertility occur at very low frequencies and genomic testing can help better manage haplotypes in herds,” said Retallick.

Retallick ended the Focusing on Fertility panel by addressing how haplotypes are a promising research endeavor. The AGI team knows that regions with missing homozygotes are present and that validating these regions would lead to additional opportunities to make genetic progress.

“As Angus breeders, you are uniquely positioned to leverage this type of research because of your dedication to growing the world’s largest single beef breed genomic database,” says Retallick.

Visit the American Angus Association YouTube channel, Angus TV, to watch the full Angus University webinar, Focusing on Fertility, and to subscribe for more educational content.

— Written by Whitney Whitaker, Angus Communications

The post American Angus Association: Focusing on Fertility Association Update appeared first on MyMedicPlus.