Assessing Risk for Cardiovascular Disease in Patients With Human Immunodeficiency Virus

Abstract

Physicians who regularly see patients with human immunodeficiency virus (HIV) are commonly asked the prognosis of someone with HIV infection today. Although the estimates vary depending on the CD4 cell count and age at diagnosis, studies suggest that survival for most people with HIV is currently measured in decades, not years.1,2 For example, in one study from Denmark the estimated median survival from age 25 in HIV-infected patients without hepatitis C was 39 years. Indeed, these per-person gains in survival accrued from antiretroviral therapy (ART) are of a magnitude unmatched in treatment of other diseases.3 Article see p 651 Effective ART has therefore led to a marked shift in the age distribution among people with HIV in the United States, and it is estimated that by 2015 more than half will be over 50 years of age.4 Given this improved survival, it is not surprising that people with HIV in whom therapy is successful are increasingly at risk for diseases of aging, in particular cardiovascular, renal, and “non-AIDS” neoplastic diseases. Furthermore, these complications seem to be occurring at higher rates than in age-matched control individuals, likely accounting for the fact that survival of HIV patients still does not match that in the uninfected population,1 even though viral replication can be controlled in the vast majority of patients in care.5 In addition, clinical observations from clinicians and patients, some of which have prominently appeared in the lay press,6,7 cite a process of accelerated aging and debility among those with HIV despite effective treatment. With cardiovascular disease (CVD) in …