A survey of physicians specializing in HIV care shows that nearly 80% of the doctors say that HIV-positive patients receiving antiretroviral treatment are at an increased risk for cardiovascular complications. The survey, appearing in a September 16 supplement to The Journal of the International Association of Physicians in AIDS Care, shows that doctors list smoking, a family history of heart disease, and the use of anti-HIV drugs as the top three risk factors for cardiovascular problems among HIV-positive adults. The surveys of nearly 600 physicians and patients were conducted by the International Association of Physicians in AIDS Care.
While scientific data has not yet proved definitively that antiretrovirals cause cardiovascular risks, most surveyed physicians said they believe such a link exists. About 69% of surveyed physicians said that of the HIV patients they treat with antiretrovirals, more than 25% have experienced significant elevations in cholesterol. More than 90% of physicians named protease inhibitors as a class of antiretroviral drugs likely to elevate cholesterol levels in HIV patients, while 34% named nucleoside reverse transcriptase inhibitors and 29% named nonnucleoside reverse transcriptase inhibitors.
Almost 70% of physicians surveyed say the perceived cardiovascular risks of antiretroviral therapy influences their choice of initial drug regimens, and 67% said they considered the possibility of increased cardiovascular risk from antiretroviral agents when considering drug or regimen switches. When the physicians were asked how they would manage HIV patients at risk for cardiovascular complications, they most commonly listed lifestyle changes, lipid-lowering drugs, and switching antiretrovirals as options.
The JIAPAC supplement, written by Judith Aberg of the Washington University School of Medicine in St. Louis and titled "Cardiovascular Risk Among HIV-Positive Patients on Antiretroviral Therapy," urges physicians to use caution and make clinical decisions grounded in scientific data. "The rapidly shifting sands in this arena make it imperative that physicians remain cognizant of and fully educated about potential cardiovascular complications and their effects on the long-term treatment of HIV-positive patients," Aberg writes. "Given the potential implications of a parallel epidemic of cardiovascular disease, there is little choice but to remain vigilant while making clinical management decisions based on what is known rather than what is hypothesized."