HIV-Infected Women at Higher Risk for Cardiovascular Issues

Researchers from Massachusetts General Hospital (MGH) uncovered a possible mechanism behind the increased risk of cardiovascular disease in women infected with HIV which may be higher than HIV-infected men. Their findings also showed increased immune system activation that may potentially contribute to the development of vulnerable plaques.

"Studies have found rates of heart attack and stroke in HIV-infected patients that are from 50 to 100 percent higher than those of uninfected individuals, with particularly high rates - almost tripled in some studies - in women," Steven Grinspoon, MD, director of the MGH Program in Nutritional Metabolism and a member of the Neuroendocrine Unit, the study's principal investigator said, via a press release. "Traditional cardiovascular risk factors only account for part of the excess risk, and previous studies from our group have found both increased immune activation and high-risk vulnerable plaque in HIV-infected men, but this is the first to assess these factors in HIV-infected women."

Researchers examined 90 participants made up of 60 HIV-infected women and 30 non-infected control participants that came from HIV clinics and community health centers throughout Boston. Infected participants had long-term diagnoses averaging 15 years. Nighty-eight percent of them were taking antiretroviral therapy, and 84 percent also carried undetectable viral loads. Researchers also took a detailed background analysis of participants including personal data and family history via blood tests and CT angiography to assess the presence of any plaques that may have been found in coronary arteries.

Findings showed that the overall presence of coronary plaques was similar in both groups. However, HIV-infected women tended to have plaque segments in the coronary arteries that were noncalcified and could pose a potential threat. In fact, 74 percent of the plaque segments showed noncalcified groups in coronary arteries for HIV-infected women, compared to 24 percent of the uninfected control groups.

The study also showed through blood tests that monocytes and T cells were higher in HIV-infected participants and older women. These higher blood levels of proteins work as activation markers for immune cells that can increase or intensity the calcification of plaque found in the arteries.

"We have found that these two factors - noncalcified plaque and immune activation - are uniquely and disproportionately increased among HIV-infected women and together may contribute to the markedly increased cardiovascular disease rates of HIV-infected women," he notes, via the release. "These results suggest that strategies to reduce monocyte and immune activation may alter that elevated cardiovascular risk, particularly in older women. It will be worthwhile to study whether adding therapies that reduce immune activation - including the statin drugs frequently prescribed to reduce cholesterol levels - to antiretroviral therapy can reduce this risk."

More information regarding the study can be found via the Journal of Infectious Diseases.