The American Heart Association (AHA) offers new guidance in preventing and managing cardiovascular disease in patients with HIV. Here are some of the group’s recommendations, published in Circulation:
• Patients with HIV should have their risk for atherosclerotic cardiovascular disease (ASCVD) assessed with the ACC/AHA ASCVD Risk Estimator or an alternative calculator.
• If any of the following risk factors are present, a person’s CVD risk may be higher than the calculated ASCVD risk: hepatitis C coinfection; metabolic syndrome, lipodystrophy/lipoatrophy, or fatty liver disease; HIV treatment failure/non-adherence; low CD4 count (less than 350 cells/mm3); or a history of prolonged HIV viraemia or delayed initiation of antiretroviral therapy (ART).
• Simvastatin and lovastatin should be avoided. Pravastatin and pitavastatin are the least likely statins to interfere with antiretroviral therapy. Atorvastatin and rosuvastatin may also be considered.
Dr. Carlos del Rio, an editor with NEJM Journal Watch Infectious Diseases, comments: “With effective antiretroviral therapy, people living with HIV (PLWH) can live near normal lives but they are at increased risk of comorbid conditions including cardiovascular diseases.