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New research shows abnormal immune activation even in very early HIV infection. Many markers of immune activation fail to normalize even when ART is initiated during the earliest stages of acute HIV infection, said Peter Hunt, MD.
Weight gain exacerbates inflammation in people living with HIV. Weight gain or mid-section obesityeven for people successfully treating HIV with antiretrovirals and with controlled viral loadsappears to not only heighten inflammation but is also linked to neurocognitive impairment.
The low-down on inflammation from an HIV doctor, by Joanna Eveland, MD. Inflammation is linked to just about every bad thing that can happen to our bodycancer, heart disease, liver and kidney failure, dementia and autoimmune disease . A few years ago, HIV specialists and researchers started talking about inflammation more and more. We noticed that people living with HIVeven those successfully treated with combination antiretroviral therapy had higher levels of inflammation than HIV-negative people.
Positive Force is a program of San Francisco AIDS Foundation offering free social and educational events. For more information or to get involved, email .
Stages Of Hiv Infection
About a month after you get HIV, you might feel like you have the flu. This is the first stage, called primary or acute HIV infection. Symptoms include:
- Swollen lymph nodes
The next stage is called clinical latency, or chronic infection. You might have no symptoms, or only mild ones, for 10 years or more.
Without treatment, as HIV keeps multiplying inside your body, youâll move into the third stage, which is AIDS. A person who has HIV is diagnosed with AIDS when they have fewer than 200 CD4 cells per cubic millimeter of blood or when they get whatâs called an AIDS-defining condition.
AIDS-defining conditions are certain cancers and illnesses called opportunistic infections.
Hiv Positive Women With Depression Have Higher Risk Of Heart Disease
Study shows that mental and emotional health is a major contributing factor.
Recent research from researchers at George Washington University has shown a positive correlation between stress or depressive symptoms and an increased risk of atherosclerosis a build-up of plaque in the coronary arteries in women living with human immunodeficiency virus .
The study, which was published in June 2020 in the Journal of the American Heart Association, followed a cohort of around 700 women, some HIV-positive and the rest HIV-negative, for seven years. During semi-annual follow ups, participants were questioned about psychosocial risk factors depressive symptoms, perceived stress, and post-traumatic stress disorder . Then coronary artery plaque was measured via ultrasound.
Both sets of women were grouped by high stress and depression versus low stress and depression.
Results showed that more than twice as many women living with HIV in the high-stress group had plaque in their arteries, compared with the women who reported low levels of stress. And plaque buildup continued over the years as stress persisted.
For the women who were not living with HIV, the prevalence of plaque did not change regardless of high or low reported levels of stress.
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What Is Mental Health
Mental health refers to a person’s overall emotional, psychological, and social well-being. Mental health affects how people think, feel, and act. Good mental health helps people make healthy choices, reach personal goals, develop healthy relationships, and cope with stress.
Poor mental health means people find it difficult to manage how they feel, think, act, or cope with stress. Poor mental health is not the same as mental illness. Mental illnesses are mental, behavioral, or emotional disorders that may not result in any impairment or may result to mild, moderate, or severe impairment that may limit or interfere with function in one or more areas of life. Mental illnesses include many different conditions, such as post-traumatic stress disorder , bipolar disorder, and schizophrenia.
A person can have poor mental health and not have a diagnosed mental illness. Likewise, a person with a mental illness can still enjoy mental well-being.
If you are living with HIV, it is important to take care of both your physical health and your mental health.
Interventional Cardiology In Hiv Infected Patients
Reports of percutaneous coronary intervention have provided mixed results. An observational study of 50 HIV+ and 50 HIV- patients undergoing PCI with the majority receiving stents, and all patients treated with aspirin and clopidogrel at discharge, found no deaths and no difference in restenosis rates at 321 days mean follow-up . However, 5 of 12 HIV infected patients followed after stenting in another study had in-stent restenosis after a mean follow-up of 16 months . Of 24 HIV+ patients admitted with acute myocardial infarction in another study, 20% had reinfarction after discharge, and 43% of those who had PCI, ended up requiring target vessel revascularization . There is a report of late in-stent restenosis in an HIV-positive patient with a drug-eluting stent 23 months after placement, and lifelong aspirin and clopidogrel therapy have been recommended .
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Cardiovascular Disease In The Context Of Combination Antiretroviral Therapy
Large HIV cohort studies have convincingly demonstrated an excess cardiovascular risk in HIV-infected individuals compared with the general population in developing countries. Based on the 10-year cardiovascular risk estimation, a disproportionate increase in cardiac events has to be expected in ageing HIV patients in the next decades . The pathophysiology of this increased risk is complex and multifactorial. On the one hand traditional risk factors including smoking may contribute to increased cardiovascular risk. On the other hand cART , as well as HIV-induced immune activation, may both further aggravate the risk of CVD.
Cardiovascular Risk And Nucleoside Reverse Transcriptase Inhibitors
Further studies then aimed at evaluating the potential contribution of nucleoside reverse transcriptase inhibitors ‘backbones on the increased cardiovascular risk in HIV patients on cART. Within the D:A:D study an increased risk for myocardial infarction in patients being treated with abacavir or exposed to this drug within the preceding 6 months was reported for the first time. These findings were confirmed by several studies, but not all. Indeed, studies are difficult to compare as patient characteristics and patient numbers vary considerably. Of note, a more recent FDA initiated meta-analysis found no association with abacavir use and increased cardiovascular risk. However, this was done mostly in antiretroviral treatment studies which included patients with no or only small risk for cardiovascular events thereby potentially limiting the findings to patients with low cardiovascular risk when starting abacavir-based cART. Within the French Hospital database short-term/recent exposure to abacavir was associated with an increased risk of myocardial infarction in the overall cohort but not in the subset of matched cases and controls who did not use cocaine or intravenous drugs . This has raised the question as to how far cohort studies can adjust for all potential confounding factors which may contribute to cardiovascular risk and which may have been over-represented in the abacavir-treated patients.
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What Are The Risk Factors For Heart Disease
Some risk factors for heart disease can be changed or controlled by lifestyle changes or medicines, while other risk factors cannot. Risk factors that can be controlled to prevent or delay heart disease include the following:
- High blood pressure
- High blood cholesterol levels
- A lack of physical activity
- Being overweight or obese
Risk factors for heart disease that cannot be changed include having a family history of early heart disease and older age.
Link Between Chlamydia Infections And Heart Disease Reported In Science
- American Association For The Advancement Of Science
- A new study shows how Chlamydia infections may be linked to heart disease. The evidence, presented in the 26 February issue of Science, suggests that Chlamydia employ a sneaky tactic known as “molecular mimicry” that triggers an autoimmune response in the host and ultimately leads to inflammation of the heart.
Washington D.C. – A new study shows how Chlamydia infections may be linked to heart disease. The evidence, presented in the 26 February issue of Science, suggests that Chlamydia employ a sneaky tactic known as “molecular mimicry” that triggers an autoimmune response in the host and ultimately leads to inflammation of the heart.
In the past, several epidemiological studies, which track the occurrence of disease in large populations, have shown an intriguing correlation between Chlamydia infections and heart disease. Until now, however, the mechanism that might link the two has remained a mystery. It is clear that both disorders are significant public health problems. Chlamydia is a primary cause of sexually transmitted diseases and female infertility, and can also cause eye infections and pneumonia in children. Meanwhile, heart disease is the major cause of death in Western societies.
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Hiv And The Cv System
Although the mechanism actually remains a matter of debate, HIV infection has been shown to increase the risk of coronary events, although it is very difficult to separately appraise the role of the virus and of the therapy. Among 4159 HIV-positive subjects included in the Keiser Permanente database between 1996 and 2001, the hospitalisation rate for CAD as well as the incidence of acute myocardial infarction were significantly higher than in HIV-negative participants . The larger cohort study of almost 4000 HIV-infected patients and more than 1 million controls reported AMI in 189 HIV and 26â142 non-HIV patients with an increased rate of AMI per 1000 person-years in patients with HIV versus those without HIV vs 6.98% ) even after adjusting for age, gender, race, hypertension, diabetes and dyslipidaemia. HIV-associated dyslipidaemia, endothelial damage/dysfunction, inflammation and hypercoagulability, which have been proposed as potential causative mechanisms of increased risk of events.
Infective Endocarditis In Hiv
The epidemiology and clinical profile of infective endocarditis in HIV infection are the same as in uninfected individuals . The one setting where HIV is associated with increased risk of infective endocarditis is intravenous drug abuse. Staphylococcus aureus, Streptococcus viridans and Salmonella species are the most common organisms and the tricuspid valve is most involved in intravenous drug users developing infective endocarditis . Nonbacterial endocarditis has been described in HIV, usually clinically silent and manifests with large, friable, sterile vegetations on the cardiac valves, which can lead to pulmonary embolization . Patients with low CD4 counts have a poorer prognosis when they develop infective endocarditis . Rates of infective endocarditis have decreased with the advent of ARV therapy . When intravenous drug use is excluded, HIV infection has not been shown to be a risk factor for infective endocarditis .
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Poor Oral Health Puts Hiv Patients At Risk For Infection
People living with HIV are vulnerable to infections and the complications from those infections can be fatal. Minor infections can escalate rapidly due to the persons weakened immune system. Therefore, people living with HIV need to be extra vigilant when it comes to safeguarding all aspect of their health, including dental health.
Poor oral health puts a person with HIV at greater risk of picking up infections that can cause their overall health to decline. In fact, over 30 oral conditions have been connected to HIV disease. Oral conditions such as mucosal lesions are common in people who have HIV and AIDS. In addition, several antiviral medications used to treat HIV causes dry mouth. With reduced saliva in the mouth, teeth have less protection against cavities.
Your mouth is the gateway to the rest of your body. Food, liquid, air, and germs all enter the body through the mouth. Dont underestimate the impact your oral health has on your overall health. Scientists continue to learn more about the link between oral health and conditions such as heart disease and diabetes. Maintaining good dental health is an important measure you can take to lower your risk of developing other health issues.
You may also be interested in the companion article: How Your General Health Issues May Impact Your Oral Health
Characteristics Of Cad In Haart
As reported in previous paragraphs, for reasons not yet completely understood, HIV-infected patients on long-term treatment have a greater prevalence of atherosclerotic disease and vascular dysfunction compared with an age-matched uninfected cohort. Additionally, as reported in cases of coronary artery disease, patients tend to manifest an illness with more aggressive characteristics, with a higher rate of ST-segment elevation myocardial infarction and multivessel involvement following the first presentation, as our group recently reported in a meta-analysis of 11 studies including 2442 HIV-patients presenting with ACS. These characteristics had a higher incidence than in contemporary ACS registries of non-HIV patients and combined together could in part explain the higher rates of in-hospital events registered for HIV patients. Conversely, other studies have reported a more favourable in-hospital outcome in absence of significant haemodynamic compromise. However, HIV-infected patients undergoing percutaneous coronary intervention could be potentially exposed to a high incidence of non-fatal myocardial reinfarction, restenosis and in-stent thrombosis, as a result of a prothrombotic state.
Modification of risk factors
The early detection and treatment of comorbidities and modifiable risk factors through lifestyle changes such as smoking cessation and dietary alterations are likely to have a significant impact on CV risk in this population.
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Myocardial Steatosis In Hiv
Cardiovascular magnetic resonance spectroscopy studies have reported increased incidence of myocardial lipidosis in HIV infected patients receiving ART, even in the absence of cardiovascular symptoms . In these studies, steatosis was associated with elevated serum lipid levels, duration of ART use and impaired strain.
Human Immunodeficiency Virus Pericarditis In The Context Of A High Tuberculosis Burden
Even though the most common cause of pericarditis in HIV in developed countries is idiopathic, tuberculosis probably remains the most common cause of pericarditis in HIV worldwide.,, In some regions Africa up to 80% of patients with tuberculosis are also infected with HIV. In this epicentre of two epidemics, Mycobacterium tuberculosis is the cause of pericardial disease in 86100% of HIV-positive patients.,,
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More About Inflammationand How It Hurts The Heart
Chronic inflammation is a symptom of HIV infection, that persists even when a person is on treatment with a suppressed viral load. And inflammation predicts cardiovascular problems in people living with HIV, although Hsue shared that the underlying cause is still not known.
Many things come together to produce inflammation, said Hsue. Even if viral loads are suppressed, HIV is not cured. HIV persists in the body, and still causes inflammation.
Researchers can measure inflammation by looking at different markers of inflammationor proteins that can be measured in the blood that reflect ongoing levels of inflammation in the body. In addition to things like smoking cigarettes, high blood pressure and high cholesterol, these inflammatory markers are strongly predictive of cardiovascular disease in people in the general population.
People at high risk for cardiovascular disease should be on a statin, said Hsue. But statins may not be the answer to targeting inflammation. How best do we reduce risk in a patient whos already on a statin? Thats what my group is studying, she said.
What Causes Heart Disease
Heart disease is caused by the buildup of plaque inside the blood vessels that carry blood to the heart. Plaque is a waxy substance made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque buildup in the coronary arteries reduces the blood flow to the heart, which can cause chest pain or a heart attack.
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Antiretroviral Medication Side Effects
ARVs in general have become easier for patients to tolerate, but a number of symptomatic side effects are still experienced. The most frequent of these is gastrointestinal intolerance, including nausea, vomiting, and diarrhea. These symptoms are commonly seen with lopinavir/ritonavir, ritonavir in combination with any PI, tenofovir, zidovudine, didanosine, abacavir and raltegravir. Efavirenz is associated with central nervous system effects, including vivid dreams, hallucinations, insomnia, and somnolence. Some of the older NRTIs, such as didanosine and stavudine, are associated with peripheral neuropathy.
Atazanavir is associated with asymptomatic hyperbilirubinemia, while nevirapine may cause fatal hepatic necrosis. Maraviroc, tipranavir, and darunavir can all cause hepatotoxicity, particularly in those patients with hepatitis C virus or hepatitis B virus co-infection. Pancreatitis is seen most often with stavudine and didanosine. A life threatening lactic acidosis can be seen with any NRTI, but most commonly with stavudine. Stevens-Johnson syndrome can be caused by nevirapine, and abacavir can cause a fatal hypersensitivity reaction characterized by fever, rash, malaise, fatigue, anorexia, and shortness of breath. Zidovudine may cause bone marrow suppression, and tenofovir frequently causes renal dysfunction, but can cause acute renal failure as well. The PIs are associated with osteonecrosis, and a resultant increase in hip fractures has been reported .
What Does My Heart And Cardiovascular System Do
Your cardiovascular system is made up of your heart, blood vessels and the blood that carries oxygen and nutrients to all areas of your body and removes waste from them.
Cardiovascular disease includes a range of conditions which affect the heart and circulation. These include coronary heart disease , stroke, deep vein thrombosis and heart attack.
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What Are Common Aids Complications
The acquired immunodeficiency disease syndrome is a complicated disease.
When someone has this syndrome, the complications can be from mild to severe.
AIDS is caused by a virus called the Human Immunodeficiency Virus . If you get infected, your body will try to fight it. This fight produces antibodies. When you get tested for HIV, these antibodies are what the lab test is looking for.
This article will discuss some of the complications that can occur with AIDS. For example, lets discuss a patient that has AIDS, and they suddenly start feeling very fatigued, has a productive cough, nausea, and diarrhea.
I will also be discussing how to properly care for your immune system if you are diagnosed with HIV.