Even when people’s HIV is well treated with antiretrovirals (ARVs), their risk of heart attack is apparently nearly double that of the general population.

This risk is likely driven by the chronic inflammatory state to which HIV gives rise, even when the virus is suppressed to undetectable levels. Lifestyle factors such as smoking, which is more common among the HIV population, also likely play a role.

Researchers also found that a standard calculator for estimating the risk of heart attack and stroke underestimates the risk for those living with HIV.

Publishing their findings in JAMA Cardiology, researchers studied a multicenter clinical cohort of people receiving care at one of five Centers for AIDS Research Network of Integrated Clinical Systems sites in the United States.

The scientists looked at data on 19,829 people who had received inpatient and outpatient care since 1995. Ultimately, they narrowed the cohort to 11,288 people with sufficient data.

The study authors found that even when members of the cohort had an undetectable viral load, they still had about a 1.5- to 2-fold increased risk of heart attack or stroke compared with the general population. The risk of heart attack and stroke was also about 50 percent higher than predicted by a common algorithm used to predict such risk in the general population.

The researchers believe that scientists should develop a new cardiovascular disease–predicting algorithm specifically for HIV-positive people.

Among the HIV-positive cohort, the rate of heart attack per cumulative 1,000 years of follow-up was higher for black men (6.9) and black women (7.2) compared with white men (4.4) and white women (3.3). The rates per cumulative 1,000 years of follow-up were also higher for people age 40 and older (7.5) compared with those younger than 40 (2.2) and for those who were not virally suppressed (6.3) compared with those who were virally suppressed (4.7).

To read the study abstract, click here.

To read a press release about the study, click here.