THIS FEBRUARY, TAKE HEART: NIH IS COMMITTED TO PREVENTING HIV-RELATED HEART ATTACKS AND STROKES

February 14, 2017 • By Carl Dieffenbach, Ph.D., Director of the Division of AIDS, NIAID

Antiretroviral therapy (ART) has transformed HIV infection from an almost-always fatal disease to what is now a manageable, chronic health condition. Today, a person diagnosed with HIV at age 20 can expect to live a nearly normal lifespan, or until about age 71—39 years more, on average, than a person with HIV diagnosed at the same age who does not take HIV medications. While we celebrate this success, we still have more to do in the ongoing effort to improve the health and extend the lives of people living with HIV.

A critical way to further improve the health and life expectancy of people living with HIV is to address non-AIDS-related illnesses magnified by HIV. One disease that often occurs alongside HIV infection is cardiovascular disease (CVD), which can lead to fatal heart attacks and strokes.

Even while taking ART to suppress the virus, a person living with HIV is up to twice as likely as someone who does not have HIV to experience heart disease. For women living with HIV, the risk of developing CVD can be as high as three times the risk of women who do not have HIV. These statistics are disheartening, especially in light of recent research

suggesting that traditional methods physicians use to assess CVD risk do not account for the effects of HIV on the circulatory system.

Since the late 1990s when implementation of ART regimens began to dramatically reduce the number of AIDS-related deaths in the United States, CVD has emerged as a leading killer of people living with HIV. This presents a “double jeopardy”

for people living with HIV who now find themselves at elevated risk of another serious disease. NIAID and the National Heart, Lung and Blood Institute (NHLBI), both parts of NIH, are committed to exploring how HIV increases CVD risk and finding ways to protect the hearts of people living with HIV. In this pursuit, our staff scientists and collaborators will use the same formula that ushered in an era of lifesaving HIV treatment with ART: innovative science and ambitious clinical research.

In an example of the latter, NIH launched the Randomized Trial to Prevent Vascular Events in HIV, or REPRIEVE

in April 2015. The study plans to enroll 6,500 participants between the ages of 40 and 75 in order to determine if a daily dose of a cholesterol-lowering statin can reduce the risk of heart disease in people living with HIV who would not normally be prescribed a statin based on traditional methods of estimating CVD risk.

REPRIEVE is the first large clinical trial to investigate a strategy to prevent HIV-related heart disease and is enrolling participants in the United States and internationally. By collecting data from volunteers throughout the world, REPRIEVE seeks to expand our knowledge of how HIV and heart disease are related, and how this connection may affect the health of men and women in the United States and beyond.

From the earliest days of the AIDS pandemic, communities affected by HIV have relied on clinical trials to yield the groundbreaking advancements needed to save and prolong lives. Now, the REPRIEVE trial and its generous volunteers have the opportunity to help transform the fight against HIV-related heart disease. To learn more about this clinical trial, including site locations and basic eligibility requirements, visit www.reprievetrial.org

Watch a conversation I had recently with some REPRIEVE trial participants in this recent Facebook Live interview from Seattle: