Dr Jorge Plutzky: Evidence Points to Patients With HIV Having an Increased Risk of Cardiovascular Disease

There is evidence that people with HIV may have increased risk of cardiovascular disease and researchers are still trying to understand why, said Jorge Plutzky, MD, director of the Vascular Disease Prevention Program and director of Preventive Cardiology at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School.

Transcript

What are some of the unique drivers of cardiovascular disease risk in patients with HIV?

The prevalence of cardiovascular disease in HIV is a really very interesting issue. Initially, there had been a lot of attention to the older age HIV medicines and the fact that they might worsen metabolic state and perhaps promote atherosclerosis. But there has been ongoing evidence that people with HIV may have increased risk and teasing that apart has many different components to it and has its own challenges in terms of trying to get those answers.

There are confounding variables of the factors that may be at work, there can be concomitant infections that are occurring and patient with HIV. There's still questions about the medicines and how those might be contributing. And very prominent has been the question about inflammation, about the fact that we now know that inflammatory processes contribute to cardiovascular disease, contribute to cardiovascular events.

And so in patients with HIV, where they have an inflammatory condition, this possibility, that it's an inflammatory picture that's contributing to the disease. Recognizing that these patients are now doing much better, and so we have to think about chronic diseases like cardiovascular disease in those patients has really opened up the eyes of many different groups are now trying to tackle that problem, you know, at the NIH [National Institutes of Health], at large care organizations, at academic institutions doing studies.

And I think it's, you know, quite interesting, important, compelling, and there, also the possibility that insights that we get from HIV will translate to other diseases where inflammation may be particularly important.

I would say one of the most striking things that I came across as we became interested in this was the observation that even patients with HIV that are known as elite controllers—people who really have very low levels of virus, that can that are even approaching undetectable—that these elite controllers still seem to have increased cardiovascular risk. So, you can't simply point at “Gosh, it's the overwhelming presence of HIV that's driving their cardiovascular issues,” there really seems to be something fundamental work. And that's what prompts a lot of questions about well, how do you evaluate that and how do you get at it?