This morning’s grand rounds at Mass General was given by Dr. Markella Zanni about HIV and cardiovascular disease (CVD) risk. A few take-home points, with my commentary interspersed:
- HIV-infected individuals with access to antiretroviral therapy are living longer and are facing increased CVD morbidity and mortality
- The challenge is reaching patients, here in the United States, and globally. Many people still fall through the cracks
- Traditional CVD risk factors contribute to, but do not fully account for, the heightened risk of myocardial infarction in PLHIV
- I still am not clear about what proportion of CVD risk is due to smoking vs hyperlipidemia or other risk factors
- Persistent immune activation among ART-treated individuals may contribute to a unique coronary atherosclerotic phenotype in HIV
- Immune activation is all the rage. It seems to be very important
- HIV-infected individuals with low to moderate “Traditional” CVD risk may benefit from statin therapy
- There is data there, but I don’t think it’s totally conclusive.
- The “REPRIEVE” trial (A 5332) will investigate this, as well as mechanisms of statin effect.
- The REPRIEVE study will be examining if Abacavir is associated with CVD. The researchers are collecting data on current ART regimen and historic ART regimens. However, their historic data on cumulative ABC use will not be comprehensive.
- Sex-specific differences in CVD risk and efficacy of CVD risk reduction strategies among PLHIV involve complex interplay between reproductive aging and immune activation
- We need to always think about subgroups, and who is at highest risk for bad outcomes. Women, IVDU, homeless, etc.
- Hepatic steatosis and inflammation need more research
- An “implementation science” study of how to reduce the burden of smoking in PLHIV would be useful.
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