HIV and Heart Disease: What's the Link?

Medically Reviewed by Carmelita Swiner, MD on August 03, 2022
Written by Paul Frysh
4 min read

You’re more likely to have heart disease if you have the human immunodeficiency virus (HIV), which causes AIDS. Scientists don’t yet know why this is, though they have some suspicions.

The term “heart disease” refers to a group of conditions caused mostly by the buildup of plaque in the walls of the arteries, which limits blood flow. This can lead to:

  • Heart attack: A blood clot in the coronary arteries stops the flow of blood to the heart. That part of the heart muscle can start to die.
  • Stroke: A blood vessel that feeds the brain breaks (ruptures) or gets blocked by a blood clot, cutting off blood and oxygen to part of the brain. This can kill brain cells and lead to problems with speech, movement, and memory.
  • Heart failure: It’s when your heart doesn’t pump well enough to meet your body’s need for blood with enough oxygen in it.
  • Heart rhythm Issues: Your heart may beat in a weird pattern (arrhythmia), too slowly (bradycardia), or too quickly (tachycardia).
  • Heart valve problems: These tiny gates between the sections of the heart may not open wide enough to let enough blood flow (stenosis). They might also not shut well enough and allow backflow of blood through the heart chambers (regurgitation) or collapse (prolapse).

 

Thanks to modern medicine, having HIV can now be a manageable condition instead of a life-threatening illness. But as more people with the virus live into old age, doctors have noticed they get heart disease more often.

Smoking, high blood pressure, obesity, and other things also raise your chances of heart disease, but even after scientists were careful to account for these things, people with HIV were more likely to get heart disease.

At first, doctors thought the primary treatment for HIV -- antiretroviral therapy -- might be to blame. But it turns out that people with HIV who get more consistent antiretroviral therapy actually have better heart health than those who take breaks from treatment.

Now scientists think HIV -- even when drugs keep it under control -- could stimulate your immune system more than usual and cause inflammation -- swelling and irritation of the tissues of your body.

Inflammation leads to plaque buildup inside your blood vessels, the primary cause of heart disease.

But research is still in its early stages, and scientists continue to study the subject for more specific answers.

For people with HIV, the odds of a heart attack or stroke are 1.5 to 2 times higher, compared to people who don’t have the virus. This is true even if you keep your viral load low with antiretroviral therapy (ART) and don’t have anything that makes you more prone to heart disease, like diabetes.

This could be related to your white blood cell count. White blood cells work as part of your immune system. A type of white blood cell called a CD4 (or CD4+ T cell) fights infection. Studies show that if you don’t have enough CD4 cells, your chance of having a heart attack goes up. CD8 cells are another type of white blood cells that destroy cells infected with viruses. If you don’t have the right balance of CD4 and CD8 cells, you’re more likely to have plaque in your arteries (atherosclerosis), which plays a major role in strokes.

Scientists are studying the data to figure out more of the details.

HIV can complicate treatment for the things that can raise your chances of a heart attack or stroke. For example, the class of drugs called statins that doctors prescribe for high cholesterol (which makes you more likely to have plaque in your blood vessels) may interact with drugs you already take to control HIV. Also, if you have HIV, your bad cholesterol (LDL) levels might look normal even though your blood vessels look inflamed. In other cases, like stroke and heart failure, doctors are still trying to figure out how HIV status might affect treatment and recovery.

That’s why it’s always important to talk to your doctor about your health history as well as all drugs and medications you take. This includes supplements and recreational drugs.

Another important approach to heart disease is to take a good look at your lifestyle. There are a number of things you can do to lower your chances of heart disease:

  • Keep moving: Regular exercise helps lower your blood pressure, cholesterol levels, and body weight.
  • Don’t smoke: Or quit if you already do. It’s one of the biggest red flags for heart disease.
  • Stay away from alcohol: If you drink, keep it to no more than a drink a day for women, two for men.
  • Maintain a healthy weight: Ask your doctor to help you with a diet and exercise plan if you’re carrying too many or too few pounds.
  • Eat a healthy, well-balanced diet: Getting enough nutrients can help your body fight disease and keep you at a healthy weight.