随着艾滋病患者寿命的延长, heart disease might be their next challenge

Medical therapy has transformed HIV from a terminal illness into a chronic, manageable condition. 但是随着艾滋病毒携带者寿命的延长, 他们还发现自己患心脏病的风险更高, 中风和其他心血管疾病.

A new 美国心脏协会 report hopes to raise awareness about that connection, along with pointing out cardiovascular disease prevention and treatment strategies for an emerging population with unique concerns researchers have only begun to explore.

“事实上，艾滋病毒感染者的寿命足够长，足以患上慢性疾病, aging-related diseases like heart disease reflects the effectiveness of contemporary HIV therapy. 预期寿命比以前长了很多。. Matthew Feinstein, a cardiologist and chairman of the committee that wrote 周一发表的科学声明 发表在美国心脏协会期刊上 Circulation.

"People are getting treated earlier and earlier and not developing immune compromise and/or AIDS-related complications, 这很好," he said. "But the downside is we're seeing earlier onset and higher relative risks for different chronic diseases among people with HIV."

心脏病是人们最担心的问题.

The risk of heart disease and stroke for people who have HIV is about 1.比未感染病毒的人高出5到2倍. 艾滋病毒相关心血管疾病占2.全世界每年损失600万年的健康生命. That's expected to increase as an aging population of people with HIV develop risks for ailments and diseases other than AIDS.

Researchers initially thought heightened risk for cardiovascular disease among people with HIV was partially linked to antiretroviral therapy, a treatment that uses a combination of medications to suppress HIV-related infections.

But recent studies knocked down that theory after finding that people who received continuous antiretroviral therapy had lower risks of having cardiovascular events than people who went on antiretroviral therapy intermittently.

Researchers now believe the elevated heart disease risk may be related to chronic 炎症 and an unusual stimulation of the immune system, 即使病毒得到了很好的控制，也会由HIV引发.

“免疫系统会对任何感染做出反应. 像HIV这样的慢性病毒感染, 人们认为在控制艾滋病毒的过程中, 可能会有一些脱靶效应," said Dr. 声明撰写委员会成员Judith Currier说.

换句话说, the immune system is activated to control HIV and in the process of that activation, 这可能会增加患心脏病的风险,柯里尔说, chief of the infectious diseases division at the University of California, 洛杉矶大卫·格芬医学院.

Chronic 炎症 is linked to the buildup of fatty plaque in the arteries, a risk factor for heart disease.

风险因素, 尤其是吸烟和高血压, 也会增加患心血管疾病的几率. 但即使在调整了这些传统风险之后, people with HIV still have significantly higher heart disease risks than people who don't have the virus.

医生们感到沮丧的部分原因是缺乏相关研究, Feinstein说, an assistant professor of medicine and preventive medicine at Northwestern University's Feinberg School of Medicine in Chicago.

"We don't have decades and decades of data on people who have well-controlled HIV because the idea of HIV as a chronic condition … is relatively new," he said. "We're just now starting to see some of these heart disease complications come up more commonly."

One 的大规模试验, 名为REPRIEVE，由美国国立卫生研究院资助, will examine whether statins can help prevent cardiovascular disease in people living with HIV.

"We're going to learn a lot from that study about how to predict risk," Currier said. "Do our risk calculators apply for people living with HIV, and the safety and efficacy of statins? It will definitely help us to fine-tune the information in (the statement) and could lead to actual formal recommendations or guidelines."

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