Researchers have found that current methods of predicting risk of heart attack or stroke in HIV-positive individuals are lacking.
There have been many successes in the fight against HIV, a virus that has infected almost 40 million individuals around the world. These advancements have changed the meaning of an HIV diagnosis; whereas previously a diagnosis was practically a death sentence, many individuals are now able to live as long as those who are uninfected. However, research is showing that these individuals are facing a number of other challenges.
Recently, researchers from the Northwestern University Feinberg School of Medicine found that those who are living with HIV have double the risk of experiencing a heart attack or stroke than those who are uninfected.
In a press release, Matthew Feinstein, MD, a cardiovascular disease fellow at the school, said, “The actual risk of heart attack for people with HIV was roughly 50% higher than predicted by the risk calculator many physicians use for the general population.”
In order to reduce their risk of heart attack and stroke, those at risk can take medications such as statins; however, they need to know that they are at risk in the first place. In this study, researchers found that current methods that are used to predict such a risk are lacking, and significantly underestimating this risk in HIV-positive individuals.
In the study, the authors wrote, “The paradigm for preventing atherosclerotic cardiovascular disease (ASCVD)—which consists of nonfatal myocardial infarction (MI), coronary heart disease death, and stoke—is based on the principle that the intensity of prevention efforts should match patients’ absolute risks. This requires accurate prediction of ASCVD risks.”
With 1.2 million HIV-positive individuals living in the United States alone, the development of a new algorithm that can effectively predict the actual risk of said individuals experiencing a heart attack or stroke is imperative.
In their study, the researchers, “using a large, multi-center clinical cohort,” analyzed data taken from 19,829 HIV-positive individuals who were being treated at one of five sites within the United States. A comparison of predicted heart attack rates based on data from the general population with the actual heart attack rates seen among the individuals in the study led scientists to believe that “the primary driver of the higher risk is the HIV.”
In the press release, Dr. Feinstein elaborated further on the team’s unsettling findings. He said, “There is chronic inflammation and viral replication even in people whose blood tests don’t show any sign of the virus in the blood. That’s because the virus still lurks in the body’s tissues, creating the inflammation that causes plaque buildup [which in HIV-positive individuals occurs 10 to 15 years earlier than those uninfected] and can lead to a heart attack or stroke. It’s this inflammatory state that seems to drive this accelerated aging and these higher risks for heart disease, which are becoming more common in HIV patients as they live longer.”
The researchers concluded that the predicted risk estimates, while not completely accurate, are still a useful tool in preventing heart attack and stroke in those living with HIV. However, a stronger, more effective predictive algorithm is needed. In fact, Dr. Feinstein and his team hope to develop such a tool themselves; they just need a larger multi-center HIV cohort to ensure accuracy.