Along with chronic inflammation, Forum members focused on metabolic syndrome, a constellation of symptoms including abdominal obesity, high triglyceride levels, low HDL (good) cholesterol, insulin resistance and hypertension “ all of which are associated with heart disease. Noting that metabolic syndrome takes on unique characteristics in HIV patients and can be exacerbated by certain HIV drugs, the panel members advocated for evaluating even young HIV patients for metabolic syndrome and taking an aggressive approach when managing lipid abnormalities. The panel also saw the need for more studies on metabolic syndrome, especially to determine the prevalence and incidence of high total, lowered HDL and increased LDL (bad) cholesterol, and high triglyceride levels “ abnormalities linked to HIV.  

At the same time, Forum members agreed more attention must be paid to assessing and treating known risk factors for heart disease in HIV patients and outlined some immediate steps to make CVD risk assessment a routine part of HIV patient care. Specifically, panel members called on clinicians to evaluate every HIV patient for insulin resistance, diabetes, kidney abnormalities and other abnormalities that might be influenced by HIV or the drug regimen.

"For now, every HIV patient should be considered at risk for cardiovascular disease," said Dr. Jur Strobos, deputy director of the Forum. "We must focus on controlling traditional risk factors, such as smoking, excess weight, hypertension, diabetes, illicit drug use and high blood cholesterol levels. Of key concern is reducing the high prevalence of smoking in people with HIV, which some studies estimate is as high as 50 percent in the HIV patient population."

The Forum convened the series of recent scientific workshops on CVD risk in HIV patients to lay the groundwork for defining the research agenda for the future, especially in light of the deficiencies in existing data from clinical trials and observational studies that have produced conflicting and sometimes controversial findings about HIV disease as an underlying risk for cardiovascular disease. Among the research priorities identified are new studies on concomitant inflammatory and immune activation, their measurement and their potential treatment.

The companion meetings, taking place in Washington, DC on June 23 and as a symposium held at the International AIDS Society meeting in Vienna on July 18, brought together infectious disease experts, cardiologists, endocrinologists, specialists from the statistical community and regulatory representatives from the Food and Drug Administration (FDA) and the European Medicines Agency (EMA).  As a follow-up to these meetings, the Forum will publish a summary report later in the year providing new recommendations for research studies and new metrics.

SOURCE Forum for Collaborative HIV Research