HIV Infection Seems to Raise Heart Attack Risk

Could HIV infection, on its own, raise heart risks? The experts aren't sure.

"HIV is a virus, so (infection) is an inflammatory state," Grinspoon said. Chronic inflammation has recently been linked to cardiovascular disease, so "one hypothesis would be that these patients have a pro-inflammatory condition," he said.

Of course, most of the patients in the study were also taking the powerful cocktail of HIV-suppressing drugs collectively known as "highly active antiretroviral therapy" (HAART).

On the one hand, "HAART suppresses inflammation, which can improve cardiovascular parameters," Grinspoon noted. "But, on the other hand, treatment with HAART also leads to worsening changes in body composition and has even more adverse effects on (blood) glucose, lipids, etcetera. So, it's a mixed bag."

Other factors may also boost heart risk for people with HIV, Johnston added.

She noted that study participants who were infected with HIV tended to smoke more, which isn't surprising given the stresses of living with the virus. Smoking remains a major risk factor for heart disease.

Johnston emphasized that the findings shouldnotmake patients wary of taking their medications.

"There's no doubt that antiretroviral therapy is saving lives, regardless of whether there's an increase in (heart attack)," she said. "The benefits of antiretroviral therapy certainly outweigh those risks."

But Johnston said that doctors who care for people living with HIV need to be "vigilant" in tracking their cardiovascular health.

Grinspoon agreed.

"Doctors need to be aware of this increased risk, and that it occurs even among young HIV patients," he said. "Sometimes with (young) patients who might have chest pain, you might not ordinarily be concerned, but we are suggesting that doctors pay serious attention to that, because there is this increased risk of cardiovascular disease."

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SOURCES: Steven Grinspoon, M.D., associate professor, medicine, Harvard Medical School, and director, Program in Nutritional Metabolism, Massachusetts General Hospital, Boston; Rowena Johnston, Ph.D., vice president of research, Foundation for AIDS Research, New York City; April 24, 2007,Journal of Clinical Endocrinology and Metabolism, online