December 2, 2009

Young HIV-Positive Women Face Higher Heart Disease Risks

Young HIV-positive women and adolescents have a number of risk facts that significantly increase the likelihood of cardiovascular disease (CVD), according to a study published online November 30 in Clinical Infectious Diseases.

Young people, notably female adolescents and young women of color, make up one of the fastest growing populations of people newly infected with HIV. Recent studies show that obesity and other CVD risk factors are also on the rise in this same population. Given that both HIV and antiretroviral (ARV) therapy can also increase CVD, there is great concern about what will happen to these young HIV-positive women over time.

To determine the CVD risk factors in young HIV-positive women, Kathleen Mulligan, MD, from the University of California in San Francisco, and her colleagues assessed 173 HIV-positive and 61 HIV-negative females—all were 14 to 24 years old, and the majority were African American or Hispanic—between 2003 and 2005. The HIV-positive young women were broken into four groups: 85 had never taken ARV therapy; 33 were on ARVs for at least three months, and their regimen included a non-nucleoside reverse transcriptase inhibitor (NNRTI); 36 were on ARVs for at least three months, and their regimen included a protease inhibitor (PI); and 19 were on ARVs for at least three months, and their regimen included neither an NNRTI nor a PI.

Roughly 40 percent were classified as overweight or obese, and nearly one half had a family history of cardiovascular disease or diabetes. Though nearly one third reported exercising regularly, a third also reported being smokers.

Tests conducted by Mulligan’s team included cholesterol and triglyceride levels, blood sugar insulin levels, fat distribution assessed by dual energy X-ray absorptiometry (DEXA) scans, and high sensitivity C-reactive protein (hs-CRP).

On many of the tests, the HIV-positive women faired more poorly than the HIV-negative women, and those on ARV therapy did worse than those who’d never been on treatment. Triglyceride levels were significantly higher in HIV-positive women compared with HIV-negative women, and the levels were especially higher in those on HIV treatment of any kind. Total cholesterol levels were higher in those receiving an NNRTI or PI.

In terms of chronic inflammation, which is growing more and more associated with cardiovascular disease risk, hs-CRP levels were significantly higher in the HIV-positive women, particularly those on an NNRTI or a non-NNRTI/non-PI regimen than in those not on treatment or not infected.

Though there were no significant differences in blood sugar control between the various groups, the higher a woman’s body mass index—a calculation based on height and weight—the greater the negative effect on blood sugar, insulin, cholesterol and triglycerides.

“Coupled with cigarette smoking, inactivity and family history of type 2 diabetes and cardiovascular disease, these factors may accelerate the lifetime risk of cardiovascular disease and other adverse events in a group that is facing lifelong exposure to ART,” conclude the authors. “These results underscore the need for a multifaceted approach to addressing risk reduction in this population.”

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