Heart health for PLHIV: some directions

Heart health for PLHIV: some directionsSean Slavin

Assistant Director (Research Programs)

Impact of long-term living with HIV

• Increased morbidity & mortality due to non-AIDS illnesses• Traditional risk factors - lifestyle, family

history.• HIV + ART lead to some co-morbidities• Aetiology is currently debated• Many of the risk factors are the same as for

the general population.

Cardiovascular disease (CVD), Coronary Heart Disease (CHD)

and Myocardial Infarction (MI - Heart Attack)

Terms

Cardio Vascular Disease, Coronary Heart Disease & Myocardial Infarction

• What are the rates among PLHIV?

• What are the risks?

• How do these compare to general population risks?

• What can be done?

Triant, V. A. et al. J Clin Endocrinol Metab 2007;92:2506-2512

Myocardial infarction rates and corresponding adjusted RR

INTERHEART:Risk of AMI with Multiple

Risk Factors

Smk DM HTN APoB/A1+2+3 all4 +O +PS All RFs

2.9 2.4 1.9 3.3 13.0 42.3 68.5 182.9 333.7

1

2

4

8

16

32

64

128

256

512

OR

(9

9%

CI)

Summary

• Increased life expectancy

• Risk of CVD important but has complex aetiology not completely understood (CD4 and certain drugs)

• Dyslipidemia may be HIV, ART or lifestyle related

• Conventional risk factors including lifestyle factors likely to be more significant and occur at higher rates in HIV+ population irrespective of cause

Risks – what we can influence

For HIV+ health promotion…

• There is much that can be done but no silver bullet

• Lifestyle risks can be reduced – there is a wealth of experience to draw on esp. mainstream health promotion agencies.

• Remain cognisant of the social determinants – poverty, stigma, homophobia

• Don’t cede all the ground to the medical profession

What are the targets

• BMI < 25

• Waist circumference < 94cm

• Cholesterol

• Blood pressure

• Improve psycho/social functioning

How do we achieve these goals?

• Exercise – at least 30mins a day

• Weight loss

• Stop smoking

• Reduce alcohol intake

• Diet – healthy eating overall but particularly reduce sodium intake

• Mental health – esp.depression

Social Context

Thankyou