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Research suggests that people living with HIV may be at a heightened risk for developing cardiovascular disease. The European AIDS Clinical Society, or EACS, has established guidelines for estimating a patient's risk for cardiovascular disease and offers recommendations for disease prevention relative to risk.
HIV positive men over the age of 40 and women over the age of 50 should be screened annually for cardiovascular disease, even if they are not taking antiretroviral therapy. A standard cardiovascular disease screening usually includes:
- An assessment of the patient's present risk factors as well as risk factors prior HIV diagnosis and before starting antiretroviral therapy
- An electrocardiograph, or ECG, reading
- Blood pressure monitoring
- Blood analysis to test for dyslipidemia
Doctors may recommend more frequent check-ups if an assessment identifies persistent lipid elevation or major cardiovascular disease risk factors.
Doctors can choose from several different risk assessment tools to best meet the patient's needs. The EACS recommends using the Framingham equation, which gauges a person's risk for having a heart attack within five to 10 years. Another assessment called PROCAM predicts the patient's 10-year risk of experiencing a coronary event. Doctors must consider the limitations of each kind of test; for example, the SCORE tool, which assesses the 10-year probability of a patient having an atherosclerotic event, was primarily developed for non-diabetic Europeans with few risk factors. Therefore, diabetic patients would require a different assessment tool.
If an assessment identifies significant risk factors, doctors should counsel patients on ways to lower their chances of developing cardiovascular disease. The EACS and the US Preventive Services Task Force recommend the following lifestyle interventions for cardiovascular disease prevention:
- Frequent exercise several times a week
- Dietary adjustments including weight reduction and adequate nutrition
- Tobacco cessation
- Treatment for substance abuse
If a patient's risk for cardiovascular disease is greater than or equal to 20 percent, providers may consider changing the patient's ART regimen. For example:
- Protease inhibitor such as ritonavir may be replaced by an NNRTI, an RAL or a different protease inhibitor that is less likely to trigger metabolic disturbances
- Stavudine, zidovudine or abacavir may be replaced by tenofovir or an NRTI sparing regimen
Modifiable risk factors like high blood pressure, abnormal coagulation and elevated lipid levels should be regularly monitored to see if lifestyle interventions are effective at risk reduction. Treatment with drugs should only be considered if benefits for the patient outweigh possible risks.