The prevalence of cardiovascular disease among women living with HIV

Those who have HIV have 1.5 to 2 times the risk of having a heart attack or stroke as those who do not. Picture: Miguel Á. Padriñán/Pexels

Those who have HIV have 1.5 to 2 times the risk of having a heart attack or stroke as those who do not. Picture: Miguel Á. Padriñán/Pexels

Published Jun 11, 2023


The cardiovascular system, which transports oxygen and nutrients to every part of your body and removes waste from it, is made up of your heart, blood arteries, and blood itself.

A variety of illnesses that have an impact on the heart and circulation are categorised as cardiovascular disease. These include heart attack, deep vein thrombosis, stroke, and coronary heart disease (the silent killer).

According to the Heart and Stroke Foundation, plaque formation inside the blood vessels (known as the coronary arteries) that transport blood to the heart is what causes heart disease.

Plaque, a waxy substance seen in the blood, is composed of fat, cholesterol, calcium, and other elements. Over time, coronary artery plaque accumulation (also known as atherosclerosis) restricts blood flow to the heart, which can result in angina or a heart attack.

Because of advancements in medical science, having HIV is no longer a fatal disease but a treatable condition.

According to a study by WebMD, those who have HIV have 1.5 to 2 times the risk of having a heart attack or stroke than those who do not.

This is true even if you use antiretroviral medication (ART) to keep your viral load low and don't have any conditions like diabetes that increase your risk of developing heart disease.

Studies suggest that this can be connected to your white blood cell count. Your immune system is supported by your white blood cells. Infection is fought by a type of white blood cell known as a CD4 (or CD4+) T cell.

A heart attack increases your risk if you don't have enough CD4 cells, according to studies. Another type of white blood cell that kills virus-infected cells is the CD8 cell. Atherosclerosis, which is a major factor in strokes, is more likely to develop in your arteries if your CD4 and CD8 cell counts are out of balance.

Obesity and hypertension increase the risk of cardiovascular disease (CVD) among women of childbearing age who are HIV-positive, especially in settings with inadequate resources.

Due to this worry, Dr Sherika Hanley, a family medicine specialist and lecturer at UKZN, decided to conduct a quasi-experimental PhD study at two clinics in the Umlazi Township in eThekwini.

The study evaluated how well routine screening and lifestyle change treatments reduced CVD risk variables in South African women with HIV.

Hanley served as the primary site investigator for the PROMOTE prospective observational trial, which was financed by US PEPFAR and carried out across four African nations to evaluate long-term outcomes for women with HIV.

Although the majority of patients had undergone successful treatment for HIV, the research site had a high prevalence of obesity. Studies at the time, mostly from high-income nations, revealed an association between HIV and CVD.

“My PhD thesis was motivated by the dearth of data from low- and middle-income nations,” she claimed.

Her research, which was co-supervised by Professors Daya Moodley and Mergan Naidoo, revealed that the study population, who ranged in age from 18 to 49, had a significant prevalence of metabolic syndrome, obesity, and abnormal HDL levels along with poor lifestyle habits.

Her intervention increased food choices, physical activity, blood glucose, and high-density lipoprotein (HDL) levels, illuminating the potential advantages of frequent lifestyle adjustment and monitoring for CVD risk factors in HIV-positive women.

In a statement, Hanley said that the study's intervention had not been successful in reducing obesity, a problem that still exists in places with limited resources like South Africa, particularly among women. In the era of dolutegravir (antiretroviral drug), interventions need to be person-centred, sustainable, and with thorough monitoring of CVD risk.

She will give an oral presentation on the results of her PhD at the international Aids conference in Brisbane, Australia, in July of this year. Her objective is to use the research, education, and experience she has already gained to position herself as a leader and resource in the field of chronic multi-morbidity, particularly with regard to HIV and non-communicable diseases in settings with low resources.

She aspires to address significant research issues related to person-centred health service delivery for people with chronic multi-morbidity and to broaden my clinical research experience to include implementation science in order to close the gaps between policy and research implementation.

HIV can make it more difficult to treat the conditions that increase your risk of having a heart attack or stroke. For instance, the statin drug class that doctors recommend for high cholesterol (which increases the likelihood that you will have plaque in your blood vessels) may interfere with medications you are already taking to treat HIV.

Additionally, even if your blood vessels appear inflamed if you have HIV, your levels of bad cholesterol (LDL) may appear normal. Doctors are currently attempting to understand how HIV status may impact therapy and recovery in other conditions, such as heart failure and stroke.

It's crucial to discuss all prescriptions and drugs you take, as well as your medical history, with your doctor. This covers dietary supplements and illegal drugs.