Heart Harmony

The past decade has been something of a whirlwind for people living with HIV and the providers who care for them. The advent of highly active antiretroviral therapy has helped countless numbers of HIV-infected people literally get a second lease on life, enabling them to live longer and engage in life in a way that people with AIDS in the first 15 years of the epidemic could never have hoped for. Indeed, the plummeting number of AIDS-related deaths gave all of us dealing with or living with HIV a bit of a break from the agony of daily grief. And as miraculous as the decline in deaths has been, there has been a price to pay for the people who are on HAART and for those treating HIV with HAART. In addition to the challenges of treatment adherence, side effects for some on antiretroviral therapy include lipid and glucose disorders as well as body shape changes'all of which, among others, can be considered risk factors for cardiovascular disease, which continues to be the nation's number 1 killer. And guess what that means. As people living with HIV disease live longer, in addition to their day-to-day fight against the virus, they have to face the same health concerns we all do as we get older, especially cardiovascular disease and its well-publicized risk factors, like obesity, smoking, elevated cholesterol levels, and a sedentary lifestyle. And while research continues on the possible effect of HAART on cardiovascular disease, there is clearly a significant relationship between HIV, HAART, and cardiovascular disease, which at the very least necessitates that health care providers recognize the importance of an integrated care approach that includes a greater understanding of the scope of a patient's health care needs, especially if he or she has several cardiovascular disease risk factors at the time of HIV treatment, or if he or she is already being treated for both cardiovascular and HIV disease. The American Academy of HIV Medicine and the American Heart Association are developing a new initiative to bring HIV specialists, cardiologists, and metabolism specialists together to basically 'get on the same page' with respect to the complexities of HIV treatment, its effect on the cardiovascular system, and its possible role as a cardiovascular disease risk factor in and of itself. The initiative'Decrease Cardiovascular Risk and Improve the Quality of Care of Patients With HIV/AIDS'aims to improve the quality of comprehensive care for people living with HIV and will include an educational campaign targeted to physicians and other health care providers, a consensus conference, and a journal publication of conference proceedings. If you are living with HIV, what are some of the factors you should be aware of in your lifestyle to minimize the risk of cardiovascular disease? Your 'nonmodifiable' risk factors include your gender, age, and genetic predisposition. That means if you are a man over 40 with a family history of heart disease, then you need to be extra careful about the 'modifiable risks' you have as part of your lifestyle, like your smoking and exercise habits, your cholesterol level, and your weight and body-fat index. Remember, it is important for you to know what your medications are and what your regimen is, and it is critical for you to be honest with your health care provider when discussing your HIV-related issues, your lifestyle, and your treatment. Being a participant in your own health care will help your provider help you get the best possible care. In the meantime, we who provide your health care will continue to educate ourselves, each other, and you so that you can be confident that your health is our utmost priority and is truly in our care. Grossman is the executive director of the American Academy of HIV Medicine.