TY - JOUR
T1 - Characteristics, Prevention, and Management of Cardiovascular Disease in People Living with HIV
T2 - A Scientific Statement from the American Heart Association
AU - American Heart Association Prevention Science Committee of the Council on Epidemiology and Prevention and Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Stroke Council
AU - Feinstein, Matthew J.
AU - Hsue, Priscilla Y.
AU - Benjamin, Laura A.
AU - Bloomfield, Gerald S.
AU - Currier, Judith S.
AU - Freiberg, Matthew S.
AU - Grinspoon, Steven K.
AU - Levin, Jules
AU - Longenecker, Chris T.
AU - Post, Wendy S.
N1 - Funding Information:
Models of integration of primary care and HIV services have been demonstrated to be feasible and effective,327 but little information is available on cost or effectiveness of specific approaches in the United States. A research agenda has been suggested for Sub-Saharan Africa that prioritizes developing evidence-based service delivery models, generating data through informatics platforms and research, and advancing research-informed policy, among other cross-cutting health system issues. The impact of interventions to reduce the burden of CVD in PLWH in the United States likewise needs to be evaluated and optimized. This will require continued funding support from the National Institutes of Health and public-private partnerships, including support from industry to study the effects of emerging therapies.
Funding Information:
NIH (grant support)†; Regeneron/Sanofi (study drug and placebo provided for trial)*; Novartis (study drug and placebo provided for trial)*
Funding Information:
NIH (research grant R01MD013493)*
Funding Information:
Gilead Sciences (My university received a research grant for our work from Gilead)†
PY - 2019/7/9
Y1 - 2019/7/9
N2 - As early and effective antiretroviral therapy has become more widespread, HIV has transitioned from a progressive, fatal disease to a chronic, manageable disease marked by elevated risk of chronic comorbid diseases, including cardiovascular diseases (CVDs). Rates of myocardial infarction, heart failure, stroke, and other CVD manifestations, including pulmonary hypertension and sudden cardiac death, are significantly higher for people living with HIV than for uninfected control subjects, even in the setting of HIV viral suppression with effective antiretroviral therapy. These elevated risks generally persist after demographic and clinical risk factors are accounted for and may be partly attributed to chronic inflammation and immune dysregulation. Data on long-term CVD outcomes in HIV are limited by the relatively recent epidemiological transition of HIV to a chronic disease. Therefore, our understanding of CVD pathogenesis, prevention, and treatment in HIV relies on large observational studies, randomized controlled trials of HIV therapies that are underpowered to detect CVD end points, and small interventional studies examining surrogate CVD end points. The purpose of this document is to provide a thorough review of the existing evidence on HIV-associated CVD, in particular atherosclerotic CVD (including myocardial infarction and stroke) and heart failure, as well as pragmatic recommendations on how to approach CVD prevention and treatment in HIV in the absence of large-scale randomized controlled trial data. This statement is intended for clinicians caring for people with HIV, individuals living with HIV, and clinical and translational researchers interested in HIV-associated CVD.
AB - As early and effective antiretroviral therapy has become more widespread, HIV has transitioned from a progressive, fatal disease to a chronic, manageable disease marked by elevated risk of chronic comorbid diseases, including cardiovascular diseases (CVDs). Rates of myocardial infarction, heart failure, stroke, and other CVD manifestations, including pulmonary hypertension and sudden cardiac death, are significantly higher for people living with HIV than for uninfected control subjects, even in the setting of HIV viral suppression with effective antiretroviral therapy. These elevated risks generally persist after demographic and clinical risk factors are accounted for and may be partly attributed to chronic inflammation and immune dysregulation. Data on long-term CVD outcomes in HIV are limited by the relatively recent epidemiological transition of HIV to a chronic disease. Therefore, our understanding of CVD pathogenesis, prevention, and treatment in HIV relies on large observational studies, randomized controlled trials of HIV therapies that are underpowered to detect CVD end points, and small interventional studies examining surrogate CVD end points. The purpose of this document is to provide a thorough review of the existing evidence on HIV-associated CVD, in particular atherosclerotic CVD (including myocardial infarction and stroke) and heart failure, as well as pragmatic recommendations on how to approach CVD prevention and treatment in HIV in the absence of large-scale randomized controlled trial data. This statement is intended for clinicians caring for people with HIV, individuals living with HIV, and clinical and translational researchers interested in HIV-associated CVD.
KW - AHA Scientific Statements
KW - HIV
KW - cardiovascular diseases
KW - preventive medicine
UR - http://www.scopus.com/inward/record.url?scp=85069295856&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85069295856&partnerID=8YFLogxK
U2 - 10.1161/CIR.0000000000000695
DO - 10.1161/CIR.0000000000000695
M3 - Article
C2 - 31154814
AN - SCOPUS:85069295856
VL - 140
SP - e98-e124
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 2
ER -