HIV Positive People Could Benefit from Aspirin to Reduce Cardiovascular Risk

		SUMMARY: Nearly one-third of people with HIV who are at increased risk for cardiovascular disease may benefit from taking daily aspirin -- a measure intended to reduce blood coagulation (clotting) and inflammation -- but few currently do so, according to a letter in the August 15, 2010 Journal of Acquired Immune Deficiency Syndromes.

By Liz Highleyman

Studies have shown that people with HIV have a higher risk of cardiovascular disease, but it is not yet clear whether this is due to HIV infection itself, chronic immune activation and inflammation, antiretroviral drugs, traditional risk factors, or some combination thereof. A growing body of evidence indicates that chronic immune activation, persistent inflammation, coagulation, and endothelial (blood vessel lining) dysfunction contribute to cardiovascular disease in HIV positive (as they do in uninfected people as well).

Carlos Tornero and colleagues from Hospital Gandia in Spain assessed how many HIV positive patients at their clinic would qualify to receive aspirin for cardiovascular risk reduction according to recent guidelines. Studies have shown that daily aspirin reduces the likelihood of heart attacks, but long-term use can damage the gastrointestinal lining and cause bleeding.

Based on a review of medical literature since 2002, the U.S. Preventive Services Task Force recommended in 2009 that men age 45-79 should use aspirin "when the potential benefit of a reduction in myocardial infarctions outweighs the potential harm of an increase in gastrointestinal hemorrhage," and women age 55-79 should do so "when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage."

Tornero's team reviewed medical records from 120 HIV patients, looking at demographic factors such as sex and age and other traditional cardiovascular risk factors including smoking, abnormal blood lipid levels, diabetes, and high blood pressure.

Results

	Based on the guidelines, 37 patients, or about 31%, could potentially benefit from preventive aspirin.
	This percentage increased to 40% when looking only at men.
	The proportion was projected to rise by 15% over the next 5 years as the population ages.
	However, only 2 people were currently taking daily aspirin -- about 2% of the total study population, or about 5% of those predicted to benefit.

"Application of the recently published recommendations on the use of aspirin in HIV-infected patients could help reduce the rise in cardiovascular events described in some studies," the study authors concluded. "[I]n the management of cardiovascular risk among HIV-infected patients, it is therefore necessary to also consider aspirin as primary prevention treatment."

8/31/10

Reference
C Tornero, A Ventura, and M Mafe. Aspirin is indicated for primary prevention of cardiovascular events in HIV-infected patients. Journal of Acquired Immune Deficiency Syndromes 54(5): 560. August 15, 2010.