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ABCs of CVD Risk Management

A: Aspirin when indicated

B: Blood pressure control

C: Cholesterol management; cigarette smoking cessation

D: Diabetes and prediabetes management

E: Exercise

Source: Post WS. Perspective: predicting and preventing cardiovascular disease in HIV-infected patients. Top Antivir Med. 2011 Dec;19(5):169-73.

Renal Disease

Renal abnormalities are common among people with HIV/AIDS and are linked with greater risk for chronic kidney disease (CKD), cardiovascular disease, progression to AIDS, and increased mortality.79,80,81,82 HIV itself, as well as traditional risk factors, such as genetic propensity, aging, diabetes, hypertension, use of nephrotoxic medication, cigarette smoking, and cocaine use, contribute to risk for and incidence of CKD among PLWHA.83,84,85 CKD is most prevalent among HIV-positive African-Americans, and certain antiretroviral agents may worsen it.86,87 Coinfection with hepatitis C virus (HCV) increases the risk and severity of renal disease in HIV-positive people.88,89 Renal impairment can complicate HIV treatment, since it increases the risk for drug–drug interactions.90,91

Early identification and management of renal abnormalities allow clinicians to prevent or delay worsening of renal disease.84 Clinicians can screen, monitor, and manage kidney disease in HIV-positive patients, using recommendations produced by the HIV Medicine Association of the Infectious Diseases Society of America. Their recommendations include initial assessment for kidney disease, annual screening for patients at high risk for development of kidney disease, and individualized treatment and referral for patients with kidney disease.92

Liver Disease

Aging, HIV itself, and ART contribute to liver damage.93 Many antiretroviral agents are metabolized through the liver; long-term use of ART, especially didanosine, have been linked to development of serious liver damage in HIV-positive people, as have heavy alcohol consumption, nonalcoholic fatty liver disease, and AIDS-related infections.94,95,96,97

Viral hepatitis is a common coinfection among PLWHA. Up to 10 percent of HIV-positive people are coinfected with HBV.98 HBV coinfection doubles the risk of progression to AIDS or death among HIV-positive people.99 Fortunately, HBV can be comanaged with HIV, since some antiretroviral agents are active against HBV as well as HIV.100

Up to 30 percent of HIV-positive people are coinfected with hepatitis C virus (HCV). HIV increases the risk for, and accelerates the rate of, serious liver damage; this includes cirrhosis, liver cancer, and liver failure in people with HCV.101,102,103 Although the risk for ART-associated hepatotoxicity is increased by HCV coinfecion, ART may delay HCV progression.104,105

HCV can be treated—and in some cases, cured—in HIV-positive patients, especially in the first six months after infection (known as the acute phase) or before cirrhosis has developed.105 Direct-acting antivirals (DAAs) that increase efficacy of pegylated interferon and ribavirin are in late-stage development in people with HIV, and are likely to significantly increase cure rates, although clinicians must be wary of additive toxicity, and drug–drug interactions between antiretroviral agents and DAAs.106,107,108

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