HIV-infected patients are living longer, with successful antiretroviral therapy. However, recent reports suggest increased cardiovascular disease (CVD) rates among HIV-infected patients (1), and cardiovascular disease has become an important cause of morbidity and mortality in this population (2). Increased CVD rates may be related to traditional risk factors, including aging of the population, higher smoking rates, dyslipidemia, insulin resistance and impaired glucose tolerance, and changes in body composition, with relative accumulation of central fat in some patients. As well, CVD may be due to non-traditional factors, including inflammation, and direct effects of the virus on the vasculature, as well as from direct effects of specific antiretroviral drugs. Significant questions remain as to the pathogenesis, detection, and treatment of coronary heart disease (CHD) and related risk factors in HIV-infected patients. These controversies include, among others, the design of adequate trials to determine disease incidence, and the utility of existing CHD guidelines for screening, treatment, and risk stratification.
To ascertain the state of the science with respect to these and related questions, a multidisciplinary conference with interested HIV specialists, cardiologists, endocrinologists, and primary care physicians, NIH representatives, and patient advocates was convened June 28th–30th in Chicago chaired by Drs. Steven Grinspoon and Robert Eckel. The discussions focused on 6 areas of interest, including: 1) Contribution of Metabolic and Anthropometric Abnormalities to CHD Risk Factors (Chairs C Grunfeld and D Kotler), 2) Epidemiological Evidence for CHD and Relationship to HAART (Chairs J Curier and J Lundgren), 3) Effects of HIV Infection and Antiretroviral Therapy on the Heart and Vasculature (Chairs M Dube and S Lipshultz), 4) Screening and Assessment of CHD in the HIV Population (Chairs P Hsue and K Squires), 5) Development of Appropriate Risk Prediction Models in HIV-infected Patients (Chairs M Schambelan, K Yarasheski, P Wilson), and 6) Prevention Strategies for CHD in HIV-infected Speakers (Chairs J Stein and C Hadigan). For each area of interest, specific topics were covered in plenary lectures and in subsequent discussions with conference participants. Summaries for each group were reported out to the conference participants for discussion, and submitted for publication (See Circulation on line for individual group summaries and list of writing group members). The proceedings were sponsored by an unrestricted educational grant from Bristol Meyers Squibb to the American Heart Association, and also by the American Academy of HIV Medicine. Per AHA guidelines, the sponsor had no role in the planning of the meeting, choice of speakers, speaker content, or formulation of the scientific summary.