Researchers share insight about strategies being studied to support the cardiovascular health of people living with HIV
When Tom Ortiz was diagnosed with HIV more than 30 years ago, he felt like he was handed a death sentence.
“In the early days, if AIDS didn’t kill you a heart attack would,” said Ortiz, a community health worker in Ohio. “It was either AIDS or a cardiovascular event.”
As a result, Ortiz got his affairs in order. “When I first acquired the disease, nobody made it very far,” he said. “A year [to live] was a long time.”
An HIV-infected T cell is shown.
Eager to find solutions, Ortiz also enrolled in clinical trials, which have since led to new therapies to control the virus that causes AIDS. Others have helped physicians identify new treatments and ways to help people living with HIV offset risks for cardiovascular disease, which can be about two times higher compared to people living without HIV.
This year, Ortiz is celebrating his retirement. He booked a cruise last year and was unsure — looking 12 months out — if he would live long enough to attend. Now, he’s looking forward to it and looking at life with a new perspective.
Following the advent of treatments that are helping adults like Ortiz live longer, researchers are building on these discoveries to identify ways to further support the cardiovascular health of people living with HIV.
For example, an international study that was published last year found that a daily statin helped adults ages 40 and older living with HIV reduce the risk of having cardiovascular events, such as a heart attack or stroke, by about one-third throughout a five-year period. The findings were significant since the study included adults who were at low-to-moderate risk for having cardiovascular events and therefore would not necessarily be considered as candidates for statins. Other researchers are focusing on ways to bring these types of findings and care to patients. “Now that there’s awareness about ways to support and improve a person’s cardiovascular health, we need strategies to implement,” said Chris T. Longenecker, M.D., a cardiologist and the director of the Global Cardiovascular Health Program at the University of Washington School of Medicine.
In early 2024, Longenecker and colleagues published results from a study in the U.S. that found nurses could help bridge gaps between HIV and cardiovascular care — a concept known as task shifting. The idea is to take the burden off physicians who specialize in HIV treatment by using other providers who can teach patients how to better manage and reduce their risks for cardiovascular disease.
The trial started with 297 adults with HIV who had both hypertension, or high blood pressure, and high cholesterol. Participants were randomized into a nurse-led care arm or to the control group. Those in the control group received health education materials and regular care from providers. Participants in the nurse-led care group received additional support from nurses, who sent them home with blood pressure monitors and called participants as needed. The nurses helped patients monitor their blood pressure at home and worked with their primary care provider to adjust their medications as necessary.
Compared to the control group, participants who received the nurse-led care lowered their blood pressure by over 4 mm Hg after one year, which is expected to reduce risks for cardiovascular events by about 14%. The participants also lowered their cholesterol by about 17 mg/dL, which is expected to reduce risks for cardiovascular events by about 9%.
Longenecker said the findings showed how healthcare providers can work together to bridge that “know-do” gap by getting effective treatments to patients in the real world. Similar results have been found in Uganda.
Researchers in Uganda conduct trainings to bring healthcare providers into HIV care models to ensure patients receive preventive cardiovascular screenings.
As part of a 21-month pilot program in Uganda, more than 1,000 people living with HIV and hypertension had their blood pressure screened at the end of their HIV care visits. They also received educational materials and treatment for hypertension at no cost. This saved patients time by consolidating medical visits and helped them learn how to reduce their risks for heart disease.
At the end of the study, 74% of participants were able to control their blood pressure compared to 9% at the start.
The researchers are now studying this approach and an enhanced care model at 16 HIV clinics in Uganda. This study is part of larger research in Africa to identify cost-effective and scalable ways to support the cardiovascular health of people living with HIV. The consortium is called the Heart, Lung, and Blood Co-morbiditieS IMplementation Models in People Living with HIV (HLB-SIMPLe) and includes other studies in Botswana, Mozambique, South Africa, Nigeria, and Zambia, which will run throughout 2025.
Last year, for World AIDS Day, researchers in Nigeria held a community-wide blood pressure screening that helped 6,000 people with HIV measure their blood pressure. Almost one in three participants had hypertension. The investigators are currently studying how to build on this awareness by bringing hypertension screenings and treatment into HIV care.
Researchers in South Africa conduct training to help healthcare providers incorporate hypertension screenings into HIV treatment and care.
“Identifying implementation strategies that work for people in the real world is necessary to achieve the goal of reducing risk for complications related to HIV,” said Keith Mintzer, Ph.D., a program officer for implementation science in NHLBI’s Center for Translational Research and Implementation Science. “The next task is to scale up and sustain successful risk-reducing strategies.”
Fred C. Semitala, MMed, M.P.H., an HIV physician leading research in Uganda, said the early success of the interventions tested stem from the initial work and outreach used to bring antiretroviral therapies to people living with HIV. He and other researchers hope that the cardiovascular care models they are studying will provide additional insight about how to incorporate care for other noncommunicable conditions, such as diabetes, mental health, and chronic obstructive pulmonary disease, into one setting for patients.
“As we treat these patients, we should be able to evaluate them for other medical conditions,” Semitala said. He explained this has far-reaching implications and the potential to improve both individual and global health outcomes.
To learn more, visit https://www.nhlbi.nih.gov/science/nhlbi-hivaids-program.