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Heart Disease in HIV
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Download the PDF here
from Jules: Here are several selected studies on heart disease in HIV. We know overall studies find increased CVD risk among HIV+ compared to HIV-neg. Here are 2 studies finding nadir CD4, recent CD4 & recent viral load all associated with heart disease, and HIV+ with CD4 >500 & viral load undetectable maybe not at greater risk for heart disease. Can we take home to the bank that high cd4 of 800 is protective or associated with no adders if viral load is undetectable. More research is needed to close the gaps in truly well understanding who is at great risk among HIV+, if its even possible to sort through all the various factors like history of drug use & IDU & its legacy affect, like inflammation & immune activation levels among those with very high cd4 of 1000 & undetectable viral load. There is the plaque study below finding greater plaque but I think 70% had undeniable viral load. We know that you can have high cd4 & undetectable viral load and still have inflammation & immune activation. Years of HIV with low cd4 <600 & detectable VL even if VL becomes undetectable - does this create a legacy bad affect you can never overcome completely, I think all these remain unanswered questions.
Of note at CROI 2020:
HIV Severity and Incident Heart Failure Among Adults in a Large Healthcare System - (03/11/20) recent viral load of 201-999 doubled risk of heart failure compared to viral loa <200. Nadir CD4 <200 doubled risk of heart failure compared to uninfected & PWH >500 cd4; recent cd4 200-499 had increased risk compared to HIV uninfected; nadir cd4 200-499 had increased risk but it was not statistically significant.
Low-level viremia during ART and the risk of death, AIDS, and serious non-AIDS events -(03/31/20)
low level viremia 200-999 was associated with increased risk for serious non-AIDS events-doubled risk, but 50-199 was not associated with increased risk......LLV was associated with increased all-cause mortality compared to virological suppression 50-999 and 200-999-doubled risk.
Women with HIV Have High Overall Burden and Early Accrual of Non-AIDS Comorbidities - (03/31/20)
50% PREVALENCE OF PHYSICAL FUNCTION IMPAIRMENT AND FRAILTY IN MIDDLE-AGED PWH - age 46-55 -(03/27/20)
HIV Increases Risk for Heart Disease; Nadir CD4 & Heart Disease in HIV
http://www.natap.org/2013/HIV/102813_01.htm
Nadir CD4 count was the only HIV-related factor independently associated with MIs, while recent CD4, recent HIV RNA, and prior ART were not significant. Traditional CVD risk factors were also associated with MIs, including older age, male sex, smoking, prior diabetes, 13 prior hypertension, and prior lipid-lowering therapy. Lets not forget the indirect affect of HIV, HIV or certain ARTs may promote worsening of traditional risk factors......"recent HIV-1 RNA of at least 500 copies/mL (HR, 1.60; 95% CI, 1.14-2.22) and recent CD4 cell count less than 200 cells/mL (1.57; 1.10-2.24) were associated with AMI (acute myocardial infarction).....Cohort Study of HIV-infected and HIV-uninfected Kaiser Permanente Members CD4 nadir <200 is a risk factor in this study.
Long-term Effects of Nitrite Inhalants on Cardiovascular and Renal Outcomes in the MACS Cohort
http://www.natap.org/2014/CROI/croi_73.htm
Heavy long-term use of inhaled nitrites (poppers) was linked to new cardiovascular disease and cancer in HIV-positive and negative gay/bisexual men in the US Multicenter AIDS Cohort Study (MACS) [1]. More than half of men in this prospective cohort used poppers.
HIV INFECTION IS ASSOCIATED WITH PROGRESSION OF HIGH RISK CORONARY PLAQUE IN THE MACS
http://www.croiwebcasts.org/console/player/37176?mediaType=slideVideo&
strongly associated in non black men. no association in black men. however point estimate was similar for calcified plaque for both non black and black men.
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