Reviewed by Dr. Vaishnavi Ganesh Adhav Dr. Vaishnavi Ganesh Adhav is a skilled healthcare professional with a Bachelor of Dental Surgery (BDS) from Maharashtra University of Health Sciences and an internship from Government Dental College. She further pursued her master’s degree at MIT World Peace University (MIT-WPU), graduating with distinction and earning a gold medal for academic excellence. With four years of industry experience, Dr. Vaishnavi has made significant contributions not only in clinical dentistry but also in the fields of women’s empowerment and Non-Communicable Diseases (NCDs). Her dedication to healthcare, coupled with her involvement in social impact initiatives, reflects her commitment to improving public health and empowering communities.

Thanks to advances in treatment, many people living with HIV (PLHIV) have near-normal life expectancies. But as PLHIV age, non-AIDS comorbidities—especially cardiovascular disease (CVD)—are becoming major concerns. Recent studies show that PLHIV have significantly higher risk of heart disease, stroke, and metabolic complications. In this post, we dig into what the data says, why cardiovascular health is so important, and what can be done to protect the heart.

What Recent Research Reveals

• A meta-analysis found that PLHIV have 16 times higher risk of cardiovascular disease than HIV-negative individuals, even after accounting for traditional risk factors (smoking, hypertension, etc.).
• In a U.S. study of adolescents living with HIV, nearly 8% had detectable viral load (“unsuppressed HIV”), which was strongly associated with increased cardiovascular risk.
• Studies report high prevalence of metabolic complications among young people with perinatally acquired HIV, including raised cholesterol, triglycerides, and early onset of conditions such as diabetes.

These findings suggest that cardiovascular health is no longer an afterthought—it’s central to long-term health for PLHIV.

Why PLHIV Are at Higher Cardiovascular Risk

1. Chronic Inflammation & Immune Activation
   Even with ART, HIV causes a state of low-grade chronic inflammation, which damages blood vessels and promotes atherosclerosis.
2. Treatment Side Effects & Metabolic Changes
   Some antiretroviral therapies (especially older regimens) are associated with lipid changes, fat redistribution, insulin resistance. Raised cholesterol and triglycerides are more common among PLHIV.
3. Traditional Risk Factors Combined
   PLHIV may also have higher rates of smoking, poor diet, physical inactivity, other infections—all adding to cardiovascular risk.
4. Viral Load & Immune Suppression
   As seen in the adolescent study, detectable viral load (VL) and low CD4 counts correlate with higher CVD risk. Maintaining viral suppression is protective.

The Real Life Impact

• Increased risk for heart attack, stroke, hypertension. PLHIV may experience these at younger ages.
• Reduced quality of life: complications like heart disease affect endurance, energy, capacity for physical activity.
• Treatment burden: managing both HIV and cardiovascular disease (CVD) means more medications, more clinic visits, more potential drug interactions.

What Can Be Done: Prevention and Control

1. Regular Cardiovascular Screening
   PLHIV should get regular checks for cholesterol, blood pressure, blood sugar. Viral load monitoring and CD4 counts matter not just for HIV, but for assessing cardiovascular risk.
2. Lifestyle Interventions
   Exercise, healthy diet, quitting smoking, managing weight are foundational. Even moderate improvements in diet or activity can reduce risk substantially.
3. ART Regimen Choices
   When possible, selecting ART with lower risk of metabolic side effects helps. Close medical supervision allows switching if side effects like hyperlipidemia emerge.
4. Early Treatment & Viral Suppression
   Suppressing viral load reduces immune activation and inflammation. Thus early diagnosis, adherence to treatment, and access to quality HIV aids treatment and services are critical.
5. Integrated Care Models
   Clinics offering combined HIV care plus cardiovascular risk management (lipid clinics, cardiology referrals) are more effective than siloed care.

Conclusion

Cardiovascular disease is one of the leading causes of morbidity and mortality in PLHIV today. With risks that are over twice that of HIV-negative populations, and significant metabolic complications even in young people, we can no longer treat heart health as peripheral. Prevention, early detection, healthy lifestyle, good treatment, and integrated care are paths forward. PLHIV deserve health that includes strong hearts, not just strong viral suppression.

Frequently Asked Questions (FAQ)

Q1: At what age should PLHIV start cardiovascular screening?
Many guidelines recommend starting in early adulthood, but especially once on ART for several years, or if risk factors (smoking, high lipid levels, family history) are present.

Q2: Can changing ART reduce heart disease risk?
Yes—some ART medications are more likely to cause metabolic side effects. Discuss with your HIV specialist doctor about safer options and monitoring.

Q3: Are there lifestyle changes that make a big difference?
Absolutely. Regular physical activity, healthy diet (low saturated fats, good fiber), quitting smoking, limiting alcohol, and managing body weight have strong evidence for reducing cardiovascular risk.

Q4: How does viral suppression affect heart health?
Maintaining an undetectable viral load lowers chronic inflammation and immune activation, which are major drivers of cardiovascular disease in PLHIV. Staying adherent to ART is protective for the heart.

Q5: Are young people with HIV also at risk of heart disease?
Yes. Research shows that even adolescents and young adults with HIV can have metabolic issues (raised cholesterol, triglycerides) and higher cardiovascular risk, especially with unsuppressed HIV.

Q6: What type of doctor should PLHIV see for heart concerns?
An HIV specialist should remain your primary provider, but referrals to cardiologists or lipid clinics are recommended for those with persistent risk factors, abnormal labs, or existing cardiovascular disease.

Other Resources:

HIV and Heart Disease