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Hypertension Increased in HIV+ vs HIV-neg in Amsterdam AgehIV Cohort Study (45% vs 31%) & HIV is Independently Associated with Hypertension
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Jules Levin, NATAP
Subclinical Heart Disease Found in HIV: "impaired strain & biomarkers of immune activation". And HIV/Aging Clinics needed in USA, As well, we need Aging Cohort Studies in the USA like the AgehIV Cohort who conducted the study below & many other studies, in Amsterdam. We are unprepared for the large numbers of HIV+ individuals who are aging into their 60s & 70s, soon to be over 40% of the entire HIV population in the USA. The federal govt needs to be responsive to these issues, they are not. Of note, HCV also causes immune activation & extra hepatic manifestations may be associated, probably is, with HCV-caused immune activation, because HCV is a virus too and viruses cause immune activation which leads to inflammation. So HIV/HCV coinfected are particularly at risk for cardiac disease, but we also know that HCV momoinfected are also at increased risk for cardiovascular disease.
from Jules: I am at the Comorbidities Workshop in Philadelphia. There are several HIV/Aging Clinics in Western Europe to provide care to aging patients. In talking with attendees at the workshop who are from Europe it is clear to them & to me that the care older patients need not only is specialized & needs a specialized clinic but in the USA the HIV clinicians often do not have the expertise to deal with these care issues & perhaps more important they do not have the time. In Europe the governments fund healthcare & work together jointly with stakeholders & they recognized the need for such clinics & the govts support them, at times with outside support. We need HIV/Aging clinics in the USA. Second, there was a disturbing study presented here that was considered very striking by the attendees. Since HIV infection is associated with an increased risk for cardiovascular disease & measures of subclinical cardiac dysfunction are increasingly used to investigate the underlying etiology of this association, researchers evaluated the relationships between measures of cardiac strain & cardiac fibrosis by MRI with traditional cardiovascular disease risk factors & biomarkers of immune activation in a cohort of HIV+ adults without known cardiovascular disease compared to matched healthy controls. They found: strain indices of systolic dysfunction were impaired in HIV+ subjects, further, subclinical impairment in systolic function was associated with markers of chronic immune activation. (we know that immune activation & inflammation persist despite undetectable HIV viral load). Similar to patients with chronic heart failure, increased levels of MCP-1, a chemokine important in the regulation of monocyte & macrophage migration & a marker of immune activation, was strongly associated with impairment in cardiac function. LBP, an acute phase protein made in response to lipopolysaccharide (LPS), was also associated with impaired cardiac strain in HIV+ patients. "Our findings indicate that subclinical impairment in cardiac strain tracks with markers of chronic inflammation & immune activation, which may serve as targets for future therapeutic strategies to optimize long-term cardiovascular health in persons living with HIV".
I regularly see my cardiologist, in fact I have had 2 echo cardiograms in the past few weeks at both my HIV doc & at the cardiologist, and they both said the results were fine & even very good, highlighting that the issue in HIV is subclinical heart disease, that which is not detected by standard testing.
The First HIV/AIDS Generation Reaches Retirement Age - (09/22/14)
Heart Disease in HCV+.......http://www.natap.org/2014/HCV/060314_02.htm
Chronic Hepatitis C Virus Infection Increases Mortality From Hepatic and Extrahepatic Diseases: A Community-Based Long-Term Prospective Study - (R.E.V.E.A.L.)-HCV study......http://www.natap.org/2012/HCV/071912_01.htm
We found that anti-HCV seropositives with detectable serum HCV RNA had an increased risk of dying from all causes of death, whereas the risk for anti-HCV seropositives with negative HCV RNA was similar to the risk for anti-HCV seronegatives......The results implied that chronic hepatitis C patients with active virus infection may benefit from antiviral treatment to reduce their overall mortality.......The results implied that chronic hepatitis C patients with active virus infection may benefit from antiviral treatment to reduce their overall mortality.
HCV Extrahepatic Mortality-kidney/heart/cancers......http://www.natap.org/2014/HCV/060114_05.htm
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Higher prevalence of hypertension in HIV-infected patients partially explained by increased waist-hip ratio
Reported by Jules Levin
16th International Workshop on Co-morbidities and Adverse Drug Reactions in HIV 6 October 2014, Philadelphia USA
RA van Zoest, FW Wit, KW Kooij, M van der Valk, J Schouten, IG Stolte, NA Kootstra, WJ Wiersinga, M Prins, BJH van den Born, P Reiss on behalf of the AGEhIV Cohort Study Group
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