Cardiovascular Risk Factors in Adults with Perinatally Acquired HIV
Overview
Adults with perinatally acquired HIV (PaHIV) exhibit significant cardiovascular risk despite effective viral suppression. In a UK cohort, 9% to 21% met hypertension criteria depending on guidelines, 3% had metabolic syndrome, and over half had elevated PDAY scores predictive of atherosclerosis.
Background
Antiretroviral therapy (ART) has improved survival for people with HIV, including those with perinatally acquired infection, normalizing life expectancy. However, non–AIDS-related comorbidities, particularly cardiovascular diseases (CVD), remain a leading cause of morbidity and mortality in this population. Traditional CVD risk factors combined with lifelong HIV-related inflammation and ART exposure may increase risk in adults with PaHIV. Standard CVD risk tools may underestimate risk in younger adults with HIV, prompting use of the PDAY score to assess subclinical atherosclerosis.
Hypertension was identified in 9% of adults with PaHIV using WHO criteria and 21% using the more stringent AHA criteria.
Metabolic syndrome was present in 3% of the cohort, indicating relatively low prevalence despite lifelong HIV and ART exposure.
More than half of participants had elevated PDAY scores (≥1) for coronary arteries (57%) and abdominal aorta (51%), suggesting increased subclinical atherosclerosis risk.
Rates of WHO-defined hypertension were similar to an age-matched UK population, but AHA criteria revealed a higher burden of hypertension in this cohort.
Despite effective viral suppression in 83% of participants, cardiovascular risk remains elevated, likely due to chronic inflammation and ART-related factors.
Current statin initiation guidelines may not adequately address the cardiovascular risk profile in adults with PaHIV.
Clinical Implications
Clinicians should recognize that adults with perinatally acquired HIV carry a substantial cardiovascular risk despite viral suppression and relatively young age. Blood pressure thresholds and cardiovascular risk assessment tools may require adaptation to better identify and manage hypertension and atherosclerosis risk in this population. Early intervention and tailored preventive strategies, including consideration for statin therapy, may be warranted.
Conclusion
Adults with perinatally acquired HIV demonstrate elevated cardiovascular risk markers, including hypertension and subclinical atherosclerosis, despite effective ART. Enhanced screening and prevention strategies are needed to mitigate long-term cardiovascular morbidity in this unique population.
References
Nash et al. 2024 -- Assessment of Cardiovascular Risk Factors in Adults With HIV Acquired at Birth
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