Harvard Heart Letter

Heart beat: Heart disease a major killer among people with HIV/AIDS

Heart beat

Heart disease a major killer among people with HIV/AIDS

When the human immunodeficiency virus (HIV) began appearing in the early 1980s, getting the virus was a death sentence. People infected with HIV died of AIDS or a related condition, often in less than a year. The introduction and combination of powerful virus-fighting medications in the mid-1990s changed the course of AIDS so much that some HIV-infected people can now expect near-normal life spans. But this often means having to worry about the increased risk of heart disease posed by having HIV as well as being treated for it.

People infected with HIV often have high triglycerides and low HDL (good) cholesterol. Their muscles don't respond as they should to insulin. They lose fat in and around muscle tissue, but gain it around the waist. They are prone to the development of artery-clogging atherosclerosis and malfunctions of the left ventricle, the heart's main pumping chamber.

The question of how best to handle the extra heart disease risk posed by HIV infection is a question addressed by a series of papers in the July 8, 2008, Circulation. Realizing that it exists is a first step, for both HIV-positive people and their doctors. Routine cardiovascular checks are in order. Sticking with anti-HIV medications is essential. Working to turn around standard heart disease risk factors "" cholesterol, triglycerides, blood pressure, blood sugar, smoking, a poor diet, and inactivity "" is also high on the list. Lifestyle changes are best, since they pose little threat of interacting with the bevy of medications needed to keep HIV at bay.

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