Slide 1: December 1 is World AIDS Day! Many parts of the world are now seeing mortality from HIV transitioning away from opportunistic infections and to chronic illnesses. Specifically, heart disease is under-treated in HIV patients. Despite being one of the major causes of mortality today, patients with HIV are less likely to receive guideline-directed statin and aspirin therapy.
Slide 2: The diagnosis of cardiovascular disease and risk is challenging in HIV. Inflammation and immune activation contribute to mostly non-calcified plaques, which limits the usefulness of common tools such as coronary artery calcium (CAC) scoring. More troubling, the traditional ASCVD risk calculator routinely underestimates risk in HIV, leading to the expert recommendation to multiply scores by 1.5 to 2.0 when using such calculators.
Slide 3: In terms of treatment, drug interactions should not preclude life-saving medications such as statins. Of the common statins, pravastatin is the least likely to interact with antiretrovirals. Finally, it is interesting to note the HIV itself may cause release of renin-like peptides that up regulate the renin-angiotensin-aldosterone system (RAAS). It may make more sense mechanistically, therefore, to prefer aldosterone antagonists for the treatment of hypertension in HIV.
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Tags: AIDS, HIV, trivia tuesday, World AIDS Day