HIV and Heart Disease – NIH Explores the Connection
June 15, 2016
HIV-positive men and women can now live longer than ever before. A 2013 study found that a newly diagnosed 20-year-old on effective antiretroviral therapy (ART) can expect to live into their 70s, a lifespan only slightly lower than in people without HIV. While this is great news, physicians are learning that chronic HIV infection can place their patients at a higher risk of developing certain health problems earlier in life. One example is heart disease.
People living with HIV are up to twice as likely to have a heart attack as those who are not infected. As some of the original HIV survivors and those infected later in life continue to age, clinical research is vital to address this growing public health concern. In light of this, the National Heart, Lung and Blood Institute and the National Institute of Allergy and Infectious Diseases, both part of the National Institutes of Health, have launched an ambitious, multi-site trial to evaluate heart disease in people living with HIV and whether a drug called a statin may be able to lower their elevated risk.
Scientists believe the risk for cardiovascular and cerebrovascular disease is elevated in people living with HIV for two reasons. First, the virus itself causes chronic inflammation in the blood vessels that make a vascular event—like a heart attack or stroke—more likely, even when viral load is suppressed on ART. Second, despite having an overall life-extending effect, ART itself appears to raise the risk for developing heart disease by raising cholesterol levels.
Statins, on the other hand, work to lower the body’s cholesterol and have been proven to prevent heart disease in the general population. However, statins have yet to be tested in HIV-positive patients who would otherwise not meet the criteria doctors normally use to prescribe them. Now, the Randomized Trial to Prevent Vascular Events in HIV, or REPRIEVE, is doing so in a large-scale, double-blinded study. Clinical investigators at research sites throughout the U.S., Canada and Thailand will track the vascular health of trial participants for up to six years as they receive either the statin drug pitavastatin or a placebo. The results of the trial will help clinicians determine the best practice to prevent HIV-related heart disease.
To obtain the most accurate and comprehensive results, the REPRIEVE trial expects to enroll 6,500 participants. REPRIEVE is seeking individuals who are HIV positive and between the ages of 40 and 75, have been on antiretroviral therapy (ART) for at least six months, have no history of heart disease (including heart attack or stroke), are not currently using a statin drug and have a low to moderate risk of developing heart disease. If you know clients who fit these criteria, consider referring them to this historic study to help address the growing problem of HIV-related heart disease. You can find a REPRIEVE research site near you or learn more about REPRIEVE by visiting reprievetrial.org or by calling 1-877-29-HEART.
REPRIEVE is also unique because investigators plan to track the data they collect based on sex, race and ethnicity. This will allow us to study any variations in the presentation of heart disease or the effectiveness of the statin drug among different demographics. Historically, knowledge about these variations have allowed clinicians to better personalize care and education for their patients. For example, thanks to research that analyzed sex differences in heart attack symptoms, we now know that women are less likely to experience chest pain before a heart attack. In light of the value of these studies, the REPRIEVE research team is using funds from an ancillary grant that was funded to analyze these sex-based differences, and recruit more female participants to the trial, in an effort called Follow YOUR Heart. Both women and men can enroll in REPRIEVE to help grow the medical community’s understanding of HIV and heart disease.
- Samji, H, Cescon A, Hogg RS, et al. Closing the gap: Increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLOS One 2013; 8(12): e81355.
- Freiberg MS, Chang CC, Kuller LH, et al. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med 2013; 173(8): 614-22.
About Sarah W. Read, MD
National Institutes of Health
Director, Therapeutics Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health
About Karin L. Klingman, MD
National Institutes of Health
Medical Officer at DAIDS/NIAID/NIH, in Rockville, MD. I work with the ACTG, IMPAACT, HPTN and INSIGHT clinical trials networks. I am involved in the START, and more recently the REPRIEVE clinical trials.