Questions and Answers with NAM Michael Carter, editor, Patient Information
Heart of the matter
Is there any additional reason for somebody with HIV
to be concerned about their heart?
Most people with HIV will experience no problems with their heart. However,
as with anybody else, if you are HIV positive, a lack of exercise, a diet
with a lot of saturated fats from red meat and dairy produce, smoking, heavy
drinking and recreational drug use can cause heart disease.
Some HIV drugs, particularly protease inhibitors, have been linked with higher
blood levels of fats that can increase risk of heart disease.
In addition, it has been suggested that long-term infection with HIV can cause
inflammation that can increase the risk of heart disease.
Okay, tell me more about heart disease
The heart is a muscle and acts like two pumps. The right pump sends blood
into the lungs to collect oxygen. The left pump sends blood, rich in oxygen,
into the body to the organs and muscles.
Damage to the heart can occur in a number of ways. A diet, rich in saturated
fats, can clog the arteries that supply the heart with blood. This means that
the heart has to work extra hard to pump blood around the body and can become
strained.
Smoking can damage arteries supplying blood to the heart, as can heavy alcohol
consumption and drug use, particularly speed and cocaine. Heart disease also
appears to run in families, so if either of your parents, or your grandparents,
had heart disease, it makes sense to take additional care of your heart.
The result can be a heart attack, angina, an irregular heartbeat, diabetes,
high blood pressure and stroke. Heart disease is the biggest killer in the
UK.
How will I know if anything is wrong?
Your clinic will test the levels of fats in your blood at regular intervals;
this should provide an early warning sign of problems. Your blood pressure
should be regularly monitored.
Tiredness, shortness of breath, an unusually rapid heart rate, and chest pains
can all be warning signs.
Severe heart problems: heart failure, angina, and heart attack have symptoms,
including pressure in the chest and pain in the jaw, back, shoulder or left
arm. If you experience these you should get medical advice immediately.
Tell me more about anti-HIV drugs and heart disease.
The level of fats in your blood may increase when you start anti-HIV treatment,
particularly if you are taking a protease inhibitor. Blood fat levels seem
particularly likely to increase when you are taking anti-HIV drugs if you
already have high blood fats or risk factors for heart disease.
A number of studies from around the world suggest people taking a protease
inhibitor may be at an increased risk of heart problems. The risk is highest
for people who already have pre-existing risk for heart disease.
What should I do to look after my heart?
The single most important action you can take is to stop smoking. If you don’t
smoke, then don’t start.
Cut down your intake of saturated fats and eat at least five portions of fresh
fruit or vegetables every day. Eating oily fish, like salmon or mackerel,
can also help reduce blood fats. Your clinic will probably have a dietitian
who can offer advice.
Take regular exercise, ideally three times a week for at least 20 minutes.
Exercise should increase your heart rate, leave you out of breath, and break
a sweat. Make sure you set yourself achievable exercise targets, and discuss
with your doctor any concerns about the safety of your exercising.
What about my choice of anti-HIV drugs?
Tell your doctor of any pre-existing risks that you may have for heart disease
before starting anti-HIV drugs. It may be possible to select a treatment regimen
that does not increase your risk of heart disease.
While taking anti-HIV drugs, the level of fats in your blood, blood pressure
and general health will be closely monitored, and you and your doctor should
discuss changes to your diet, exercise patterns or HIV treatment if any test
results suggest that your HIV drugs are increasing your risk of heart disease.
Drugs, called statins and fibrates, can also be prescribed by your doctor
to control your blood fats.
• NAM provides information to help you think about your use of HIV treatments,
but this is not intended to replace discussion with your doctor.
Visit NAM at www.aidsmap.com
