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.”

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A study that was presented at the Radiological Society of North America annual meeting evaluated the effects of different sports on degeneration of the knee joint in overweight patients with osteoarthritis (OA) and found that racket sports—such as tennis and racquetball—sped up the degeneration process.

“In our study, progression of overall knee joint degeneration was consistently higher in overweight and/or obese patients engaging in racket sports,” said lead study author Silvia Schirò, MD, of the University of California San Francisco and the University of Parma in Parma, Italy, when discussing the findings. “We also found that workouts using an elliptical trainer were associated with reduced progression of overall knee joint and cartilage defects. Moreover, our findings showed that when comparing different low impact activities with each other, such as bicycling, elliptical trainer and swimming, the elliptical trainer was associated with the lowest increase in WORMS (Whole-Organ Magnetic Resonance Imaging Score) sub-scores over 48 months.”

Dr. Schirò and her colleagues assessed 415 participants with a mean age of 59 ± 8.6 years, all of whom had a body mass index (BMI) >25 kg/m² and knee radiographic Kellgren-Lawrence score <3. The average BMI was 30 kg/m² ± 3.5, and 44% of participants were female. Patients were recruited from the Osteoarthritis Initiative cohort. Patients reported whether they regularly took part in ball sports, bicycling, jogging/running, elliptical trainer, racquet sports, and swimming. The modified WORMS was used to assess structural knee abnormalities.

Over a two-year period, participants who regularly took part in racquet sports had much greater increases in WORMS compared to those who regularly used the elliptical trainer (average difference in changes in WORMS, 4.98; 95% confidence interval [CI], 1.86–8.10; P<0.001) and who reported regular jogging/running (average difference in changes in WORMS. 2.88; 95% CI, 0.42–5.33; P=0.009).

“A large lateral force imparted at the foot during side-to-side movements may be driving large knee adduction moments, a key feature in medial compartment disease, which imparts high compressive loads on the medial tibia and femoral condyle,” Dr. Schirò said. “In support of this premise, the racket sports group showed elevated cartilage degeneration in the medial tibia.”

While the data suggest that some people may benefit from switching to other sports—such as swimming—there are safe ways to play racquetball sports, and degeneration may not be the same in everyone, according to Dr. Schirò.

“It is possible that some individuals with sufficient strength and motor control may be able to safely play these sports,” she noted. “Our data suggests that as a group, though, overweight and obese individuals who play racket sports are at higher risk for disease progression.”

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Among patients with HIV who are in care, the rate of hospitalization for any cause declined substantially during a recent 10-year period, according to study findings published in The Journal of Infectious Diseases.

Hospitalization rates declined despite the potential effects of aging, comorbidities and cumulative exposure to HIV and antiretrovirals, researchers said.

In their study, Thibaut Davy-Mendez, PhD, a post-doctoral fellow in the department of psychiatry and behavioral sciences at the University of California, San Francisco, Stephen A. Berry, MD, PhD, associate professor of medicine at Johns Hopkins University School of Medicine, and colleagues examined trends in all-cause and cause-specific hospitalization rates between 2005 and 2015 to assess the possible impact of ART improvements, aging and comorbidities on hospitalizations among people living with HIV (PLWH) who are receiving care.

The study included PLWH receiving care in six clinical cohorts in the United States and Canada.

Among the 28,057 patients ultimately included in the study, the median CD4 increased from 389 to 580 cells/µL, and the proportion of patients who were virologically suppressed rose from 55% to 85%.

According to the researchers, the unadjusted all-cause hospitalization rate decreased from 22.3 per 100 person years in 2005 (95% CI, 20.6-24.1) to 13 per 100 person years in 2015 (95% CI, 12.2-14). Additionally, unadjusted rates decreased for almost all diagnostic categories, whereas adjusted rates decreased for all-cause, cardiovascular and AIDS-defining conditions. They increased for non-AIDS-defining infection and were stable for most other categories.

According to Davy-Mendez and Berry, previous data showed similar results. Data from the 2000s revealed a decrease in hospitalization rates among PLWH but slight increases in cardiovascular and kidney disease hospitalizations. Additionally, more recent studies in North Carolina and Italy found a continued decrease in hospitalization rates among people with HIV through 2016.

“Our study is the most recent work reporting hospitalization trends across a large number of people living with HIV in the United States and Canada,” they said. “Based on previous studies, we expected that non-AIDS-defining infections would make up a substantial percentage of hospitalization reasons. However, we did not expect to see a small increase in the adjusted hospitalization rate [of] non-AIDS-defining infections.”

They said this finding will require further investigation to understand the drivers of these infections and possible ways to prevent them.

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The high-dose influenza vaccine (HDIV) demonstrated a 50% reduction in influenza-like illness (ILI) compared with the standard dose in HIV-infected patients, according to research presented atIDWeek, held virtually from October 21 to 25, 2020.

In a retrospective cohort study, conducted at the University of Kansas Medical Center, included 219 patients with HIV during the 2017-2018 influenza season. The median age was 53 years and 197 patients (89.9%) were men. Within the cohort, 13.7% had a HIV viral load greater than 40 copies/mL and 5% had CD4 count less than 200 cells/µL. HDIV and standard dose influenza vaccines (SDIV) were administered to 119 patients (54.3%) and 77 patients (35.2%), respectively, and 23 patients (10.5%) were unvaccinated.

A modified CDC definition of ILI, defined as fever and cough, sore throat, or shortness of breath occurred in 8 patients (10.4%) in the SDIV group compared with 6 patients (5.0%) in the HDIV group (P =.16). A broader protocol-defined ILI, defined as sore throat, cough, or shortness of breath with either fever, chills, headache, or myalgia was reported in 16 patients (20.8%) and 12 patients (10.1%) of the SDIV and HDIV groups, respectively (P =.04). There was no difference in confirmed influenza cases between groups. Vaccine side effects were mild, occurring in 11 patients (14.3%) in the SDIV group compared with 13 patients (10.9%) in the HDIV group (P =.5). Vaccine dose (SDIV odds ratio [OR], 2.34; 95% CI, 1.04-5.37; P =.04) and age in years (OR, 0.97; 95% CI, 0.94-1.0; P =.045) were associated with protocol-defined ILI. HDIV remained protective regardless of age.

The CDC reported an influenza attack rate of 14.7% in US adults and an overall vaccine effectiveness of 38% for the 2017-2018 influenza season. This study “demonstrated a 50% relative reduction in protocol-defined ILI with the HDIV compared [with] standard-dose vaccine our HIV clinic in 2017-2018,” study authors concluded. Investigators, therefore, recommended a larger prospective randomized control trial on the effectiveness of the HDIV in HIV patients.

Disclosure: One study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of author’s disclosures.

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In view of the reported role of parasitic infections in causing morbidity among HIV-infected patients with low CD4+ counts who are on antiretroviral therapy (ART), mainly because of immuno suppression, researchers sought to determine the extent of intestinal parasitic infection and related risk factors among HIV-infected patients attending ART clinic at Debretabor General Hospital, Northern Ethiopia. Among 383 HIV-infected patients attending the ART clinic, intestinal parasites had an overall prevalence of 25.3%, with 18% and 23.8% by direct wet-mount and formol ether–concentration technique, respectively. HIV/AIDS patients thus exhibit relatively higher prevalence of intestinal parasitic infection. Illiteracy, reduced CD4+ counts, and absence of a toilet were identified to have great influence on the distribution of intestinal parasites. Hence, they emphasize consistently diagnosing HIV/AIDS patients with low CD4+ counts for intestinal parasites with routine stool examinations, and advocate inclusion of awareness creation as an essential component of ART-monitoring strategies for improved patient care.

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The prevalence of HIV among patients hospitalized with coronavirus disease 2019 (COVID-19) appears to be higher compared with the general population, suggesting an increased susceptibility to COVID-19 among people with HIV, according to research presented at IDWeek, held virtually from October 21 to 25, 2020.

To determine the prevalence of HIV in patients with COVID-19 and the relationship between people with HIV and higher COVID-19 mortality rates, researchers conducted a meta-analysis using PubMed, Scopus, OVID, Web of Science, and Cochrane Library databases, including grey literature from January 1 to June 15.

Of the 14 studies analyzed, 8 were in the United States, 3 in Spain, 1 in China, 1 in Italy, and 1 in Germany. Of the 144,795 patients hospitalized with COVID-19, 592 included people with HIV.

The pooled prevalence of HIV in patients with COVID-19 was 1.22% (95% CI, 0.61-2.43%), double the prevalence of 0.65% (95% CI, 0.48-0.89%) in the general population. The pooled HIV prevalence among patients with COVID-19 in the United States was 1.43% (95% CI, 0.98-2.07%), which was significantly higher than Spain’s prevalence of 0.26% (95% CI, 0.23-0.29%), but not significantly higher than China’s prevalence of 0.99% (95% CI, 0.25-3.85%).

The pooled mortality rate among hospitalized patients with COVID-19 and HIV was 14.09% (95% CI, 5.78-30.50%), and the rate was highest in the Unites States compared with the other countries.

Findings suggest that people with HIV may have a higher susceptibility to COVID-19. While mortality rates are high, they “vary significantly across countries,” investigators concluded.

Reference

Ssentongo P, Heilbrunn ES, Ssentongo AE, et al. Prevalence of HIV in patients hospitalized for COVID-19 and associated mortality outcomes: a systematic review and meta-analysis. Presented at: IDWeek 2020; October 21-25, 2020. Poster 393.

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14 out of 630 patents, with no history of diabetes during COVID-19 treatment, were diagnosed with diabetes at follow up clinics.

CHENNAI: Newly found diabetes among COVID-19 recovered patients is becoming a serious health condition, observed doctors in Chennai. Out of the 630 people who visited the post-COVID follow up clinic at the Rajiv Gandhi Government General Hospital, doctors said 14 people were diagnosed with diabetes.

This phenomenon has been observed worldwide lately by experts, who are trying to understand whether and how COVID-19 might be triggering diabetes among those who didn’t have the disease before. A senior doctor in-charge of the follow-up clinic said that none of the patients had diabetes during their stay at the hospital and it is only found weeks or even a month after their recovery.

“While most people who returned to the hospital with poor health conditions were aged above 45, the people with newly found diabetes post-recovery were just aged between 40-45,” the doctor said.

The doctor said that while breathing issues and myalgia (muscle pain) have been the common health condition that majority of people have come up with, the diabetes is something new. “Sugar checks are mandatory as part of COVID checks. Even for diabetes patients, insulin shots are given to keep sugar in check during treatment,” said that doctor, adding that the reason for people developing diabetes post-COVID recovery is not known.

The medico added that the patients are given insulin shots and are directed to undergo routine treatment for diabetes. Doctors said that the hospital keeps check of the patients’ health condition daily for 14 days after discharge and most patients returned back with health conditions after two weeks.

Steroids a possible reason?

Dr V Mohan, chairman, Dr Mohan’s Diabetes Specialities Centre, said high doses of steroids during the COVID-19 treatment could be a reason for sugar levels going up post-discharge. “Initially, patients are given intravenous steroids and subsequently, it is reduced to oral doses before the doses are stopped. Sugar levels too are supposed to reduce after this but some people without any diabetes too show high sugar levels post discharge,” Dr Mohan said.

He said that it is unknown whether COVID -19is directly involved in the increase in sugar levels but steroids could possibly have an impact. Various studies globally have highlighted that the immunosuppressive tendencies of steroids facilities in sugar levels are going uncontrolled among patients.

Dr Subramanian Swaminathan, Infectious Diseases Specialist at Gleneagles Global Health City said this trend of patients developing diabetes is seen worldwide. “Whether COVID-19 has caused diabetes or unmasked diabetes, we don’t know yet,” he said.

Dr Swaminathan said that even patients with mild COVID are developing diabetes later on. “In such a scenario, we can’t say the medicine is solely responsible for causing diabetes. Maybe it just has some part to do with this,” he said. Dr Swaminathan added that chronic fatigue syndrome, intermittent fever and inflammatory syndrome are widely observed among patients post-recovery.

“Unless we follow up on more patients, we won’t know the exact reasons for health complications. It is a good initiative to have follow up clinics and we need to expand it,” he said.

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Forty patients were give home-monitoring devices that regularly send data to the Dubai Diabetes Centre.

Diabetics need regular medical check-ups to prevent complications. But what if a patient could get all the monitoring done at home and doctors could receive updates in real-time? Experts in Dubai have started a study that could determine how virtual check-ups and telemonitoring could benefit people with diabetes. 

The Dubai Diabetes Centre (DDC) on Tuesday announced that they are currently testing a telemonitoring system, with 40 patients selected for the research. Home monitoring devices, a smart pill box, mobile technologies and a software were all provided to track daily patient data, allowing specialists to plan interventional strategies. 

“Diabetes requires one to have regular follow-ups to avoid complications. In general, over time, patient compliance reduces and they tend to miss follow-up appointments,” explained Dr M. Hamed Farooqi, director of the DDC.

“Even a gap of three to six months with no follow-ups can be severely detrimental to diabetic patients, especially those with other comorbidities. Therefore, the aim of this study is to provide diabetics with home monitoring devices and regularly receive data from them so that we can keep a close eye on their condition.”

The study shall be carried out until the end of December and it is expected to be completed by early next year, he added. Once done, the centre will evaluate how effective telemonitoring is and whether it should incorporated within the system.

How the study works

Each patient taking part in the DDC study was given four home-monitoring devices: A blood pressure monitor, a blood glucose monitor, heart rate monitor and pulse oximeter. There were also provided with a pill box, which beeps every day at the time their medicine needs to be taken.

If they don’t take the medicine on time or miss the medicine, the data is immediately sent to the centre.

Patients were also given a mobile phone. They need to place this phone close to their monitoring devices whenever they use them. 

“The mobile has the software which captures all the patient data and automatically sends it to our centre. In the data room, the data gets automatically triaged as green, yellow and red based on artificial intelligence,” Dr Farooqi explained.

“Green means the results are fine, yellow means the readings are slightly abnormal, and red means the patient needs intervention. If the data falls under the yellow category, the patient is automatically sent a push notification, which informs him that the results are slightly abnormal, and therefore the patient needs to take the necessary measures as already advised by healthcare providers. 

“If the data falls under the red category, the patient gets a call from DDC and the healthcare provider can provide a phone consultation or request them to visit the centre for further consultation.”

At the end of every week, a doctor receives a comprehensive patient report, said Dr. Farooqi. “This kind of real-time monitoring helps the patient stay on track and ensures there is no time-gap in terms of physical consultation, which means complications can be greatly reduced.”

Currently, a video call feature is also being tested for the study. 

Healthcare innovation

The study was announced during the visit of Humaid Al Qutami, director-general of the Dubai Health Authority, to the centre.

Al Qutami said: “The DHA strongly focuses on technology to improve patient care and drive down costs of healthcare. In the current healthcare climate, globally, there has been a surge in the importance of telehealth. 

“At the DHA, we aim to continue employing various technologies that fit the nuances of the healthcare landscape in the emirate…We are keen to continue medical research, especially in the field of healthcare and technology, to help empower patients and improve patient care and compliance.”

Currently, diabetics have home-monitoring devices which they use to check their blood sugar and blood pressure. They store the data in the devices and whenever they go for their follow-up appointment – which is typically every two to three months – the endocrinologist reviews the data in one go. During this period, if the numbers are higher than usual, the patient has to contact the DDC and schedule a phone consultation or an appointment.

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Award-winning Wirral author and breast cancer survivor Estelle Maher, who was diagnosed with breast cancer in 2019, is preparing to lift the lid on her own experience with the publication of a new book.

The Killing of Tracey Titmass is the author’s third novel and it will be officially launched during a virtual event on October 29 to coincide with Breast Cancer Awareness Month which runs throughout October.

The book, which is written in diary format, re-tells Estelle’s own roller-coaster journey of living with cancer, through the eyes of fictional character Jo Kearns and it’s hoped it will help others suffering with the disease.

Both humorous and poignant, the inspiring tale covers the raw emotions and physical discomforts associated with diagnosis, surgery, treatment and life post-cancer.

In the story Jo’s cancer tumour is given a life of its own and is personified through the character Tracey Titmass – an unwanted housemate, who has long overstayed her welcome.

Esther, says she hadn’t planned on turning her own experiences into a book.

I kept a diary because writing helped me to come to terms with my own emotions. It helped to stop my head feeling so fizzy and was to some extent, medicinal. I hadn’t planned on turning it into a book but then friends suggested that it might help others going through a similar experience.

“It took me several attempts. It sounds daft but at first I didn’t feel comfortable with inflicting cancer on a character. I know it’s all fictional but it just seemed too cruel and emotionally I found that very difficult.

“But, once I’d decided to write the book in diary format and attribute my own timeline of events to the character, it became a bit easier to write. It was more personal and all the interactions and hospital appointments are all based on true events and things that really happened to me.

“I want people to read it and not feel isolated. Many of the emotions you experience through something like this are normal and I want people to know they’re not on their own. Cancer never really goes away and learning to live with that and cope with life afterwards is an important part of the message within this book. Cancer doesn’t define you but it does become a part of your identity in so many ways.”

There will be a virtual Q&A session with Estelle on October 29 at Write Blend bookshop on South Road, Waterloo, Liverpool, Merseyside, as part of the official book launch.

Bookshop owner Bob Stone will interview Estelle during the Facebook Live session and fans will be invited to ask questions.

The book, published by Southport-based publisher Beaten Track Publishing, will be available to purchase from Write Blend and also online at Amazon. Her debut novel Grace and the Ghost is an Amazon Bestseller and also won the award for Best Spiritual Fiction Book at the 2018 Soul and Spirit Awards.  Sequel Angel’s Rebellion was published in 2018.

For more information about author Estelle Maher visit her website

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Patients with four-class drug-resistant HIV have a high burden of disease and “worrying” rate of malignancies, according to findings published in Open Forum Infectious Diseases.

Around 25% develop a clinical event or death within 4 years, researchers from Italy reported.

“Because of the high burden of disease in people living with HIV (PLWH) with 4-class drug-resistant (4DR) virus, close prevention and monitoring interventions are highly recommended, especially in people with a history of clinical events and low CD4+/CD8+ ratio,” the researchers wrote. “In PLWH with 4DR virus, efforts to favor access to drugs with new mechanisms of action are also urgently needed in order to achieve undetectable HIV-RNA load, preserve immune system, prevent clinical progression and ultimately improve quality of life.”

The researchers examined patient data from 148 PLWH with documented resistance to four drugs — nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs) and integrase strand transfer inhibitor (INSTI) — via the PRESTIGO Registry. They analyzed the incidence of death, various clinical events and the burden of disease, which they defined as the occurrence of new events, including AIDS or non-AIDS-defining events or death.

Among the 148 patients, 38 patients experienced 62 new events or died (incidence rate [IR] = 9.12/100 person-years of follow-up [PYFU]; 95% CI, 6.85-11.39). The new events included 12 deaths, 18 AIDS-defining events and 32 non-AIDS-defining events. Cumulative death incidence across 4 years was 6% (95% CI, 3%-13%). The risk for death or new clinical events was higher among PLWH with pervious clinical events (adjusted HR = 2.67; 95% CI, 1.07-6.67).

The authors said the study’s major limitations included the absence of a control group.

“Although, clinical records were carefully monitored, we cannot exclude a potential underestimation of clinical events, especially of non-AIDS-related events and mortality for which a link with the national death registry is not available in Italy,” the researchers wrote. “Another issue is related to the recent establishment of the PRESTIGIO Registry: Recorded people are those who survived a previous potentially fatal event and, for this reason, we might have underestimated the true incidences of AIDS-, non-AIDS-related events and death.”

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Early intervention and primary care are crucial for managing HIV. Not receiving this care can lead to health complications and costly hospital visits for people infected with HIV, a new study found.

The study, published in Open Forum Infectious Diseases, analyzed the health records of 2063 people infected with HIV who received care at St. James’s Hospital in Dublin, Ireland, from October 2014 to October 2015.

“A small number of people living with HIV (PLWHIV) with mental health, addiction and social challenges (eg homelessness) don’t engage in outpatient HIV care and end up really sick and needing a lot of expensive hospital care,” Clíona Ní Cheallaigh, MB, MRCP, PhD, associate professor, Department of Clinical Medicine, Trinity College Dublin and consultant physician at St. James’s Hospital, told Contagion^®. “We could potentially save a lot of money by helping these people take their ART and maintain their health.”

Investigators found that 22 of 2063 patients had cumulative hospital stays of longer than 30 days during the study period. These high-cost, high-need users logged 99 emergency department visits and 1581 inpatient bed days, costing the hospital about $1 million during the study period. For 18 of those patients, the requirements that brought them to the hospital were potentially preventable, including 2 who had a late diagnosis of HIV and 16 who had advanced HIV.

“The amount of money (nearly 1 million euro on just 1 year’s worth of hospital care) was much more than we expected,” Ní Cheallaigh told Contagion^®. “This money could potentially have been used more effectively in preventing these people becoming sick—ie by providing them with housing, social supports and addiction care.”

In Ireland, HIV care and antiretroviral drugs are provided free of charge at university teaching hospitals like St. James’s, with primary care provided by general practitioners working as independent contractors. General practitioner care is provided free for individuals with low income.

Barriers to relatively inexpensive primary care, including addiction, psychiatric disease and homelessness, affected 14 of 16 patients in the study who were not successfully engaged in care.

“It’s important to look at how well everyone can use healthcare systems – some people may find it challenging and may end up with a lot of potentially preventable illness (and costs),” Ní Cheallaigh told Contagion^®.

During the study period, 208 of 2063 patients had one or more unscheduled inpatient admissions. The 22 who had more than 30 days of cumulative hospital stays accounted for 1581 of 3380 HIV-related bed days (47%). Patients who had not been successfully engaged in HIV care showed consequences including organ failure, cancer and infection.

“We hope to look at alternative models of care (eg assertive outreach models of integrated health and social care) to see if these work better at keeping this type of patient healthier,” Ní Cheallaigh told Contagion^®.

Recent efforts to combat HIV have focused on early intervention and retention in care. In the United States, it is estimated that 85% of people living with HIV have been diagnosed, 62% have received medical care, and 48% have been retained in care. A recent study examined rapid initiation of antiretroviral therapy, finding that starting ART on the day of a diagnosis or at the first appointment is safe, well tolerated, leads to earlier viral suppression, and may increase retention in care.

Another study looked at the benefits of linking incarcerated people with HIV care upon release from jail. These patients often have barriers to care such as mental illness, substance abuse and homelessness. Implementing programs with transitional care coordinators responsible for patient engagement and education could reengage individuals lost to care and link diagnosed people to treatment.

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HIV patients who self-identify as religious or spiritual, pray daily, attend religious services regularly and say they feel God’s presence, tend to have better emotional and physical well-being, according to a new study published online in the journal Psychology of Religion and Spirituality.

In contrast, “privately religious” HIV patients — potentially turning away from organized religion due to fears about being stigmatized or ostracized — had the lowest levels of quality of life and more mental health challenges.

“These findings are significant because they point to the untapped potential of encouraging patients living with HIV who are already religious to attend religious services regularly,” says Maureen E. Lyon, Ph.D., FABPP, a clinical health psychologist at Children’s National Hospital, and senior study author.

“Scientific evidence suggests that religions that present God as all-powerful, personal, responsive, loving, just and forgiving make a difference in health-related quality of life,” Lyon said. “By contrast, belief systems and religions that see God as punishing, angry, vengeful and distant and isolate members from their families and the larger community do not have health benefits or contribute to health-related quality of life. People who identify as spiritual also benefit from improved overall health-related quality of life.”

In general, patients living with HIV have reported that they wished their health care providers acknowledged their religious beliefs and spiritual struggles. Additional research is needed to gauge whether developing faith-based interventions or routine referrals to faith-based programs that welcome racial and sexual minorities improve satisfaction with treatment and health outcomes.”

More than 1 million people in the U.S. live with HIV, and in 2018, 37,832 people received an HIV diagnosis in the U.S., according to the Centers for Disease Control and Prevention (CDC). In 2017, the Washington, D.C. region was recorded as one of the nation’s highest rates of new cases of HIV: 46.3 diagnoses per 100,000 people, according to the CDC.

For the study, the researchers wanted to better understand the degree of religiousness and spirituality reported by people living with HIV and the interplay between religion and health-related quality of life. The research team recruited HIV patients in Washington, D.C., to participate in a clinical trial about family-centered advance care planning and enrolled 223 patient/family pairs in this study.

Of the participants, 56 percent were male; 86 percent were African-American; 75 percent Christian; and the mean age was 50.8 years.

The researchers identified three distinct classes of religious beliefs:

• Class 1 (35 percent of the patients) had the highest level of religiousness/spirituality. These were more likely to attend religious services in person each week, to pray daily, to “feel God’s presence” and to self-identify as religious and spiritual. They tended to be older than 40.
• Class 2 (47 percent of patients) applied to privately religious people who engaged in religious activities at home, like praying, and did not attend services regularly.
• Class 3 (18 percent of patients) self-identified as spiritual but were not involved in organized religion. They had the lowest overall level of religiousness/spirituality.

Class 1 religiousness/spirituality was linked to increased quality of life, mental health and improved health status.

“Being committed to a welcoming religious group provides social support, a sense of identity and a way to cope with stress experienced by people living with HIV,” Lyon said.

“We encourage clinicians to capitalize on patients’ spiritual beliefs that improve health — such as prayer, meditation, reading spiritual texts and attending community events — by including them in holistic treatment programs in a non-judgmental way.”

In addition, the researchers encourage clinicians to appoint a member of the team who is responsible for handling religiousness/spirituality screening and providing referrals to welcoming hospital-based chaplaincy programs or community-based religious groups.

“This is particularly challenging for HIV-positive African-American men who have sex with men, as this group faces discrimination related to race and sexual orientation. Because HIV infection rates are increasing for this group, this additional outreach is all the more important,” she added.

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Medical cannabis was found to exhibit an overall positive effect on maintaining nightime sleep in patients with chronic pain, but frequent use was associated with problems of both waking up at night and falling asleep, according to study findings published in the journal BMJ Supportive & Palliative Care.

Chronic pain is a debilitating condition affecting approximately 19% to 37% of adults in developed countries. Among those affected, there are high rates of comorbid insomnia, which causes symptoms such as difficulty initiating sleep, disrupted sleep, and early morning awakenings. Research on MC has exhibited positive, yet small effect sizes as a pain reliever, with further efficacy being reported on managing sleep.

“Research has demonstrated that the endocannabinoid system has a role in the regulation of sleep, including the maintenance and promotion of sleep,” said the study authors.

They note that many of the studies reporting a significant and positive impact of MC use on sleep are of poor quality due their small size and because the legal status of MC varies, warranting further examination on the growing popularity of MC to manage sleep problems and chronic pain.

The study authors examined the association between the use of whole plant cannabis and sleep problems among 128 patients with chronic pain (mean age, 61 ± 6 years; 49%, males), distinguished as MC users (n = 66) and nonusers (n = 62). Regression models tested the differences in sleep problems between the 2 study cohorts, with Pearson correlations between MC use measures (dose, length and frequency of use, number of strains used, tetrahydrocannabinol/cannabidiol levels) and sleep problems assessed among MC users. The results were adjusted for age, sex, pain level, and use of sleep and antidepressant medications.

Among the entire study cohort, 24.1% reported always waking up early and not falling back asleep, 20.2% reported always having difficulties falling asleep, and 27.2% reported always waking up during the night. Of the comparative study results, MC users were shown to be less likely to wake up at night than nonusers (mean: 4.59 vs 5.54; P = 0.018), with no further differences found in sleep measures between the groups.

In a final analysis of the MC users, Pearson correlations showed that frequency of MC use was the sole association with sleep issues, indicating the potential significance of tolerance among MC users. “Specifically, more frequent use was associated with more problems related to waking up at night and problems falling asleep,” said the study authors.

The researchers highlighted that limitations to the study, including MC administration and specific strain usage, may signal differential effects on sleep, warranting the need for future studies to examine this variability in more detail.

“These findings may have large public health impacts considering the ageing of the population, the relatively high prevalence of sleep problems in this population, along with increasing use of MC,” said the study authors.

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Up to 150,000 Irish blood pressure patients may not need additional drug treatment despite new guidelines suggesting they do, according to new research.

The study by the National Institute for Prevention and Cardiovascular Health (NIPC) in Galway and the National University of Ireland Galway calls into question the validity of recent changes to treatment recommendations for up to a quarter of the 600,000 Irish people who are being treated for high blood pressure.

US and European guidelines for treating hypertension were recently changed in that high blood pressure was redefined as 130/80, instead of the previous level of 140/90.

As a result, as many as 150,000 patients with a bottom blood pressure number of over 80, but a normal top blood pressure number below 130, are potentially at risk of being overtreated, according to the US-Irish research.

This is because the study found that this specific type of blood pressure pattern does not appear to be adversely affecting their health.

Blood pressure levels are denoted by two numbers, with the top number known as the systolic, and the bottom number as the diastolic reading. The top number records blood pressure when the pressure is at its highest, ie when the heart muscle squeezes out the blood. The bottom number is when the heart relaxes and allows the blood to flow back into the heart.

The study, published in the Journal of the American Medical Association, found the recommendation to lower the diastolic threshold for hypertension from 90 to 80 was based on expert opinion – a relatively weak type of evidence – not on results from clinical trials.

Target

Prof J William McEvoy, medical and research director of the NIPC, said despite differences between them in the definition of high blood pressure, US and European guidelines both recommend the target of 130/80 be achieved for those receiving treatment to lower their blood pressure.

As a result, their doctors could be aiming to get the diastolic (lower) number to less than 80 despite the patient having a normal systolic (top) blood pressure of below 130.

“This is a concern, because our team found no adverse health outcomes from a diagnosis of isolated diastolic hypertension [normal top number but higher bottom number] when the new guideline criteria are used.

“The absence of negative health outcomes in this group challenges the need to intensify the blood pressure treatment of these adults with higher diastolic blood pressure. Instead the main focus should be on getting the top number [systolic blood pressure] under control.”

High blood pressure, which usually has no symptoms, is regarded as a major risk factor for heart disease and stroke.

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BEIJING (BLOOMBERG) – China is using AbbVie Inc’s HIV drugs as an ad-hoc treatment for pneumonia caused by the novel coronavirus while the global search for a cure continues.

The Beijing branch of China’s National Health Commission (NHC) said that a combination of lopinavir and ritonavir, sold under the brand name Kaletra by AbbVie, is part of its latest treatment plan for patients infected by the virus, which has killed at least 56 people in China and sickened more than 2,000 worldwide.

The NHC said that while there is not yet any effective anti-viral drug, it recommends patients are given two lopinavir and ritonavir tablets twice a day and a dose of alpha-interpheron through nebulisation twice daily.

Medical journal Lancet said on Friday that a clinical trial is under way using ritonavir and lopinavir to treat cases of the new coronavirus. Meanwhile, China’s Centre for Disease Control and Prevention will start developing a vaccine, according to the Global Times.

Wang Guangfa, a respiratory expert at Peking University First Hospital in Beijing who was infected by the virus after visiting Wuhan to inspect to coronavirus patients, told China News Week earlier this week that his doctor recommended he take the HIV drugs to fight the new virus and they worked on him.

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