With decades of improvements in the development and use of combination antiretroviral therapies (cART), life expectancy among people living with HIV/AIDS (PLHA) has improved. But as people with HIV get older, they are developing age-related illnesses at a higher rate than other people.
For example, PLHA have been reported to be up to 1½ to 2 times more likely to have cardiovascular disease (CVD), and an increased risk of heart attacks, heart failure, stroke, and sudden cardiac death.1 In the Asia-Pacific region, much remains to be done to address CVD as a growing cause of illness among those living with HIV/AIDS. Research on CVD risk and management among HIV-infected people in the region is limited. More concerted efforts are required to prioritize research so that we may better understand the noncommunicable disease burden among PLHA in the region, how best to assess risk, and how to target diagnosis and treatment.2
Dr. Jeremy Ross (center) with TREAT Asia and Kirby Institute investigators, Bangkok, February 2016
Several factors are thought to be associated with the increased risk of CVD among PLHA, including direct damage to the heart muscle, persistent chronic inflammation and immune activation, and side effects associated with cART. Unfortunately many PLHA also smoke, which increases the risk of CVD. Many have other traditional CVD risk factors as well, including high blood pressure and high blood cholesterol. These factors likely play key roles as people age.
Continuing to adapt to emerging research needs, the TREAT Asia network is addressing these challenges and contributing to the regional evidence base to inform policy, programming, and service delivery. Through its "Think Tank” initiative, TREAT Asia has conducted a comprehensive HIV and CVD literature review to gather information on the prevalence of CVD and risk factors among Asian populations, and to develop relevant research studies.
“There is a clear need for CVD prevention and management to be integrated into HIV care,” said TREAT Asia Research Director Dr. Jeremy Ross. “We and others in the field are working to develop specific guidance on how this can be best accomplished. CVD risk assessment tools and prediction models need to be tested for HIV populations in Asia, and all HIV-infected patients should be routinely assessed and counseled for CVD risk. In addition, more people in Asia need improved access to some of the newer antiretroviral medicines that are less likely to increase the risk of CVD.”
The Think Tanks have been helping to prioritize research questions for TREAT Asia research network investigators. As well as refining CVD risk assessment in Asian populations, targeted areas for study include characterizing current CVD diagnosis and management practices in the region, and determining the prevalence of metabolic syndrome in the TREAT Asia HIV Observational Database (TAHOD) cohort.3
In addition, TREAT Asia is expanding research under the NIH-funded IeDEA global consortium to include data collection on CVD risk factors (such as family history of diabetes or hypertension), outcomes (e.g., heart attacks, stroke), and medications (e.g., statins, beta-blockers, diuretics).
“TREAT Asia is pleased to be playing this role to address this growing public health issue,” said TREAT Asia Director Dr. Annette Sohn. “If our aim is to improve the health, lifespan, and quality of life for people with HIV, we must address coexisting medical issues as an essential aspect of treatment.”
1 Risk of Cardiovascular Disease in an Aging HIV Population: Where Are We Now?
R. Martin-Iguacel J.M. Llibre N. Fris-Moller
Curr HIV/AIDS Rep (2015) 12:375-387
2 HIV and Noncommunicable Diseases: The Asian Perspective
Jintanat Ananworanich and Anchalee Avihingsanon
J Acquir Immune Defic Syndr Volume 67, Supplement 1, Sept 1 2014 S99-103
3 HIV and Cardiovascular Disease. Unpublished Research Summary
Yulyana Y. 2016