The following is a video and transcript excerpt from an interview conducted with David Alain Wohl, M.D., discussing highlights and clinical takeaway messages from the 2021 Conference on Retroviruses and Opportunistic Infections (CROI 2021), which took place in March. In this video, Wohl talks through new findings that further our understanding of the interplay between HIV and comorbidities we typically associate with aging, particularly those related to cardiovascular disease.
I think [about], for me, the highlights that maybe stand out a little bit differently than the usual data about people getting older, or the silver tsunami that we're going to see with more and more people living with HIV being not only just over 50, but then over 60.
Certainly, there were those studies: the confluence of aging, frailty risk factors, structural issues, poverty, food insecurity, marginalization, discrimination, sexism, racism, homophobia, that just conspire to lead many people living with HIV to do poorly as they get older. There was that. But I think there were some other things that I thought were helpful.
I'm a big fan of some of the data that come out of Kaiser Permanente. And Michael Silverberg does really just a tremendous job of looking objectively at data at hand from that wonderful database that they have there. And I think it's been able to continue to refine our understanding of how people living with HIV who are in their healthcare system differ from people without HIV.
This has been always really hard, because how do you find the right control group? And I don't think that's what they're trying to do at Kaiser. They're just saying, "Here's the differences. And we're going to try to explain the differences as much as possible."
I think, again, these are the data, the group, that's helped us understand it over time. The rates of myocardial infarction among people living with HIV has started to approximate—get closer and closer to—the rates that we see in people without HIV, over time, with better antiretrovirals, earlier therapy, and more statin use and other preventative methods.
So, I really pay attention when data come from Michael and his group. They've done another analysis with large numbers of people, of course, with HIV and without HIV. And it did show, I think, interestingly, when you look at the risk factor assessment of cardiovascular disease for people with and without HIV in their system, they've been able to find that there were some differences that could be explained. But they're, again, not due to the things that we've thought they would be due to in the past, like composition of your antiretroviral therapy. It really has a lot to do with your established traditional risk factors.
And for people living with HIV, there was more cardiovascular disease, but it had nothing to do with, you know, some of the things that I think we spend a lot more of our time dealing with, and more to do with things that people like me may not be as adept at.
So, interesting: There were similar rates of hypertension, dyslipidemia, and diabetes control by HIV status. But there was worse triglycerides among people living with HIV—which I think any of us who'd care for HIV know about—but actually better A1C levels. So, better diabetes control. And that may have to do with the frequency with which we check that and see people, compared to people without HIV who don't have that opportunity to do that in their clinics.
Cardiovascular risk was 26% higher in people living with HIV with no history of dyslipidemia, hypertension, and diabetes—but 35% higher cardiovascular disease risk in people living with HIV with adequate hypertension control, and 91% higher in people living with HIV with inadequate hypertension control.
So, again, hypertensions seem to be in their analysis to really be a ticket towards reducing cardiovascular disease—above and beyond many of the other things that we spend a lot of our time [thinking] about. And I will admit that cardiovascular disease prevention by controlling hypertension seems simple, but it is actually complicated for many of our people. And sometimes, I need help even from a nephrologist.
And so, I think this is really somewhat validating of the concern many of us have that uncontrolled hypertension is a big deal—including risk for renal disease, and as well for cardiovascular disease—maybe more so than anything else that we do, including maybe lipids; certainly, diabetes management, hyperlipidemia control. But I think hypertension may be neglected relative to those other things. So, that was important for me.