Heart Trouble Early and Often in HIV Patients

People with HIV, even those whose virus is well-suppressed by treatment, have a greater risk of heart attack than their uninfected peers, and at an earlier age, new research shows.

Dr. Priscilla Y. Hsue, a cardiologist at San Francisco General Hospital, and colleagues reported their findings, which confirm a link that some AIDS experts have long suspected, in the Journal of the American College of Cardiology.

"I think most cardiologists and most HIV specialists are not really aware of this," said Hsue, who treats many AIDS patients in her practice. "Most of the people I see are referred to me after they've had a heart attack, a bypass, a stent. To me, that's too late. We should be screening people for coronary disease, aggressively treating blood pressure, aggressively treating cholesterol."

Dr. Paul M. Ridker of Harvard Medical School, who was not involved with Hsue's research, but who led pioneering studies establishing the connection between heart disease and inflammation, said both HIV and the drugs to treat it cause chronic inflammation that likely increases the risk of heart attack. HIV medicines cause the liver to make more cholesterol, he said. In addition, HIV can cause "leaky gut syndrome," in which inflammatory microbes enter the blood.

Jose Raneda, a 48-year-old former attorney from Milwaukee, has known he was HIV-positive since age 21. He started on HIV drug cocktails as soon as they came on the market and never had a low CD4 count or an AIDS-related infection. Though always slim, Raneda had his first of two heart attacks at age 40. "I asked my HIV doctor if it was related, and he said it wasn't," he said.

"At the time, we didn't have a lot of solid evidence of the connection," said Dr. Ian H. Gilson, Raneda's former physician at the Medical College of Wisconsin. "I'd tell him something different now."

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