Understanding the Link Between HIV and Heart Disease

As Gerald S. Bloomfield, M.D., saw heart patients in Kenya over the past decade, he knew that cardiovascular disease was on the rise in the country. But he also noticed another trend. Many of the patients who came in with heart issues also had HIV.

“We scratched our heads and asked, ‘Is there something to this?,’” recalls Bloomfield, a Duke associate professor of medicine and global health who works in Kenya through AMPATH, a network of academic institutions partnering with Kenyan health centers. “No one knew we were sitting on a time bomb of heart disease.”

Bloomfield wasn’t alone in seeing the correlation. An emerging area of research is showing that people living with HIV may have twice the risk of experiencing a heart attack or stroke. While the exact reasons for the link are not yet clear, the findings are leading doctors to think differently about how to manage heart health in an aging population of people living with HIV.

Some answers are coming from a large-scale clinical trial that is tracking the cardiac health of patients with HIV across several countries. Bloomfield has been part of the study since 2018 and last year was a co-author on a landmark study published in the New England Journal of Medicine, which showed that HIV patients with low to moderate risk of cardiovascular disease could benefit by taking pitavastatin, a statin commonly used to lower cholesterol. Patients who took pitavastatin had a 35 percent lower incidence of heart attack or stroke over a five-year period, according to the study.

“We know statins prevent heart attacks and deaths so that was the rationale to take a low-risk group of people and give them a moderate, intensity statin,” Bloomfield says. “[Pitavastatin] has a low side effect profile and doesn’t interact with antiretroviral drugs, and that’s why it was chosen.”

The clinical trial, which started in 2013 and is the first to follow heart health in an HIV population, highlights another significant trend. Among the 7,700 patients in the study group, the average age is 50, reflecting the fact that since the introduction of antiretroviral therapies, many people with HIV are living longer.

Markella Zanni, M.D., a physician-scientist at Massachusetts General Hospital who is vice chair of the trial. Says this shows the need for more research on how to manage age-related health problems alongside HIV.

“It is important to develop strategies to improve the health span among people aging with HIV,” says Zanni, who is also an endocrinologist and HIV researcher at Harvard Medical School. “We are very grateful to our study participants whose dedication to advancing research has made the work possible.”

 Because HIV causes inflammation and weakens the immune system, it can increase the risk of other diseases and illnesses. Bloomfield notes, for example, that most HIV patients are dealing with at least two other health conditions.

Those interconnections also point to the need to continue to move away from the siloed treatment of HIV that was often the rule in low- and middle-income countries. In the early days of the epidemic, HIV clinics often didn’t even have equipment to monitor blood pressure or other conditions, Bloomfield says. In Kenya, he has helped bring in a more integrated approach.

“For patients with [the virus], they lean on their HIV doctor for a lot of their care or even all of it,” Bloomfield says. “It’s meaningful for patients to be with a physician they can trust who knows about HIV and heart disease.”

In coming years, researchers plan to explore whether pitavastatin could help HIV patients with lower risks of cardiovascular disease maintain heart health, as well as what effect it might have on other diseases that can accompany HIV.

“The rise in heart disease in those with HIV is happening all over the world,” Bloomfield says. “What’s amazing about this study is it’s lifesaving."