HIV patients have nearly twice the heart attack risk than the general population, warns a new study which found that current prediction methods vastly underestimate the risk of cardiovascular diseases in people with the deadly virus.
The higher risk for heart attack - about 1.5 to two times greater - exists even in people whose virus is undetectable in their blood because of antiretroviral drugs, researchers said.
"The actual risk of heart attack for people with HIV was roughly 50 per cent higher than predicted by the risk calculator many physicians use for the general population," said Matthew Feinstein from Northwestern University Feinberg School of Medicine in the US.
Accurately predicting an individual's risk helps determine whether they should take medications such as statins to reduce the risk of heart attack or stroke.
"If you have a higher risk for heart attack or stroke, your ability to benefit from one of these drugs is greater and justifies the possible side effects of a medication," Feinstein said.
A new predictive algorithm may need to be developed to determine the actual risk for heart attack and stroke in people with HIV, he said.
An estimated 1.2 million people in the US have HIV with 35 million to 40 million infected worldwide, researchers said.
The study was conducted using a large, multi-centre clinical cohort of HIV-infected individuals receiving care at one of five participating sites around the US.
Researchers analysed data from about 20,000 HIV-infected individuals. They compared predicted rates of heart attacks based on data from the general population to the actual rates of heart attacks observed in this cohort.
The primary driver of the higher risk is the HIV, scientists said.
"There is chronic inflammation and viral replication even in people whose blood tests don't show any sign of the virus in the blood," Feinstein said.
That is because the virus still lurks in the body's tissues, creating the inflammation that causes plaque buildup and can lead to a heart attack or a stroke.
Plaque buildup occurs 10 to 15 years earlier in HIV patients than in the uninfected population.
"It is this inflammatory state that seems to drive this accelerated ageing and these higher risks for heart disease, which are becoming more common in HIV patients as they live longer," Feinstein said.
In addition to inflammation and other effects from the virus as factors in higher heart attack and stroke rates, said Heidi Crane, associate professor of medicine at the University of Washington.
"Despite these differences, we found that risk scores developed in the general population - while not as accurate as we would like - are still useful in assessing risk in HIV populations," said Crane.
The study was published in the journal JAMA Cardiology.
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