HIV Infection Raises Risk of Heart and Kidney Disease

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People with HIV infection are at increased risk for both heart and kidney disease, according to a new study.

That study found that people at high predicted risk for both cardiovascular disease (CVD) and chronic kidney disease (CKD) events have substantially greater risks for both CVD and CKD events compared with those at low predicted risk for both outcomes and those at high predicted risk for CVD or CKD events alone.

Study results appear in the November 7, 2017 in PLoS Medicine.

Lead author Mark Boyd, an infectious diseases expert, led an international team to investigate additional diseases associated with HIV infection and its treatment. The researchers used data from the international D:A:D (Data collection on Adverse events of Anti-HIV Drugs) study, a prospective observational study that combines 11 cohorts of more than 49,000 HIV-positive people followed prospectively since 1999.

Their analysis included 27,215 participants, average age 42 years (74% of them men), with enough data to calculate CVD and CKD risk scores. They calculated the CVD and CKD event rates by predicted 5-year CVD and CKD risk groups (≤1%, >1%–5%, >5%) and analyzed whether CVD and CKD risk group effects were multiplicative.

“Our research found that people with HIV at high risk of cardiovascular disease had a corresponding 5.63-fold increase in risk of chronic kidney disease – a finding not consistent with the general community,” said Boyd. Those at high CKD risk had a 1.31-fold increase in CVD events compared to those at low risk. Participants’ CVD and CKD risk groups had multiplicative predictive effects, with no evidence of an interaction.

HIV-positive people not uncommonly have high predicted CVD and/or CKD risk; these interact to create substantial risks for future events, they noted. “Our results suggest that CVD and CKD risk in HIV-positive people should be assessed together. The results should further encourage clinicians to prioritize addressing modifiable risks for CVD and CKD in HIV-positive people,” stated the researchers.

Boyd added: “This study adds to the international body of research that shows we need to pay close attention to the broader, general healthcare of people living with HIV. It's wonderful that anti-HIV medication has been able to save the lives of so many with HIV; what we need to do now is to help people with HIV realize the full potential of their much-extended life expectancy.”

Despite much effort over the past decade to focus attention on reducing cardiovascular risk in HIV-positive people, there has been a lack of attention to the management of CVD in people living with HIV. “Unfortunately, this has implications for other diseases, and the interaction between diseases creates substantial risks for future life-threatening events,” said Boyd.

“Primary prevention and effective management of these diseases, prioritizing interventions that have been repeatedly shown in the general community, will convey the same if not greater benefits for the population of HIV-positive people. This approach should be incorporated in to the development of guidelines and defining future research priorities for HIV-positive people.”