Three-quarters of docs think that HIVers face increased heart-disease risk, finds an August survey by the International Association of Physicians in AIDS Care (IAPAC). Nearly half (43 percent) of the 143 doctors said they would first recommend lifestyle changes (exercise, diet, no smoking) to HIVers with questionable heart health. Others would prescribe lipid-lowering meds (27 percent) or switch HIV drugs (5 percent). One in four didn’t report recommending any intervention.

St. Louis’ Judith Aberg, MD, who reviewed the results, says that doctors shouldn’t necessarily let heart worries influence which HIV meds they initially prescribe. Studies haven’t yet determined whether elevated lipids and other heart risks result from HIV, the meds, lifestyle, genetics or just plain aging. Indeed, Aberg says, “I’m going to treat the HIV first. If, then, a patient develops risk factors for heart disease, I’ll deal with those.” But Daniel Skiest, MD, a Dallas HIV specialist, says, “For a while now, I’ve been hesitant to use protease inhibitors up front with my patients. We have plenty of drugs to start a patient on that don’t cause lipid abnormalities.”

Meanwhile, lifestyle changes can help. Of the 431 HIVers also surveyed by IAPAC, 52 percent smoked—twice the national average—but just 49 percent reported concern of cardio risk. Skiest says patients ask more about diarrhea, nausea and body shape changes than heart disease.