HIV+ Patients and Cardiovascular Risk

[traumaRUs, MSN, APRN]

Before there was AIDS and HIV, there was Kaposi sarcoma and Pneumocystic jirovecii pneumonia (PCP). These frequently caused death and often led to a diagnosis of AIDS. Later, it was discovered that human-immunodeficiency virus or HIV was the causative agent of AIDS. The leading cause of death in 1995 in the US for those ages 25 to 44 was AIDS. Many cases went undetected until the individual became ill.

"As of 2017, studies have shown that a person living with HIV who is on regular antiretroviral therapy that reduces the virus to undetectable levels in the blood is NOT able to transmit HIV to a partner during sex. The current consensus among medical professionals is that "undetectable = untransmittable."

"Recently, a team of nurses and physicians has received a four-year, $3 million grant from the National Heart, Lung, and Blood Institute to extend traditional HIV treatment protocols to improve the cardiovascular health of people living with HIV.

According to the investigators, people living with HIV are nearly twice as likely to experience cardiovascular disease as uninfected populations. The project is a joint effort of the School of Medicine and Frances Payne Bolton School of Nursingat Case Western Reserve University, and Duke University School of Medicine.

The nurse-led intervention calls for HIV-positive participants to be screened for cardiovascular risk factors and receive outpatient and in-home follow-up care to help reach blood pressure and cholesterol treatment targets over the course of one year.

"People living with HIV may think to themselves, 'I always thought I would die of AIDS, so why do I need to worry about heart disease?'" said Chris Longenecker, co-principal investigator on the award, assistant professor of medicine and pathology at Case Western Reserve School of Medicine and director of the Research & Innovation Center at University Hospitals Harrington Heart & Vascular Institute. "In fact, more are now dying of non-AIDS conditions like heart disease, but they still do not feel like they are at high risk. The result is that people living with HIV are prescribed cardiovascular prevention therapies at lower rates than the general public."

"We've had significant and sustainable success in making HIV a chronic, treatable disease that we are now in a position to focus on preventing a growing problem in this population-cardiovascular disease," said Allison Webel, assistant professor of nursing and co-principal investigator on the award.

The study's third principal investigator is Hayden Bosworth at Duke University School of Medicine.

A major challenge in connecting people living with HIV to proper care is a changing workforce, say the researchers. The number of HIV specialists is declining, despite a growing patient population reflective of improved public health and diagnostic strategies. Patients are most likely to receive their care from primary care physicians, nurse practitioners and physician assistants-a trend seen across medical specialties.

Aligned with these trends, the newly funded intervention relies on nurses to provide evidence-based cardiovascular care to HIV patients. Nurses will coordinate baseline cardiovascular assessments, manage medications, oversee at-home blood-pressure monitoring and measure adherence and outcomes using electronic medical records. Nurses will also, more broadly, provide support for study participants.

According to the researchers, models that promote shared responsibilities between HIV specialists and nurses exist, but their effect on non-AIDS outcomes like cardiovascular disease has not been rigorously studied.

The researchers plan to begin enrolling HIV patients in the intervention by the end of this month. Their hope is that their outcomes could inform specific treatment guidelines for blood-pressure and cholesterol monitoring in HIV populations. They also hope to learn best practices to adapt cardiovascular interventions to this specialty population."

Providing improved care and cardiovascular screening is important to extending the lifespan of HIV+ patients as well as improving their quality of life.

References:

Case Western School of Medicine Press Release

The History of HIV

[pro-student]

It's worth noting that both HIV and ART are risk factors for heart disease independent of age. The pathophysiological mechanisms are not totally clear but it appears that systemic inflammation and possibly immune reconstitution play a role in the HIV-specific increase in risk. Not only do aging HIV-positive individuals need screening for cardiovascular disease but all HIV-positive individuals should receive more intensive primary and secondary prevention.

Medscape: Medscape Access