Heart and Bone Health Protection for People with HIV on ART

How HIV and HIV Medications Affect Your Heart and Bones

HIV causes increased immune response and inflammation that persists at lower levels even when the virus is well controlled.

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This increases your risk for a range of chronic conditions, including cardiovascular disease and osteoporosis (weakened bones). If you’re on certain older HIV medications, your risk for heart and bone issues is even greater, but don’t change or stop taking any prescription medications, including your ART, without speaking with your healthcare provider first.

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HIV and the Heart

Compared with the general population, people with HIV have higher rates of heart attack, heart failure, and sudden cardiac death because of the ways HIV affects the heart.

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“It could be a heart muscle issue, a blood clotting issue, or a timing issue with the heart itself,” says Dominic Chow, MD, PhD, MPH, a professor with the Hawai’i Center for AIDS and the University of Hawai’i Department of Medicine.

“The way I really think of it, and the way I explain it to patients, is that HIV is a risk factor for cardiovascular disease,” similar to having a family history for it, smoking, or living a sedentary lifestyle, adds Jill Blumenthal, MD, an infectious-disease specialist with UC San Diego Health.

Research also suggests that certain older HIV medications can increase your risk for cardiovascular events. “[It] can cause a disruption of the body’s metabolic homeostasis [balance],” leading to diabetes and cholesterol issues, both of which raise cardiovascular disease risk, Dr. Chow says. For this reason, the medications abacavir and lopinavir/ritonavir are not recommended if you have a high risk of cardiovascular disease from lifestyle and clinical factors.

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HIV and Bones

Because of its inflammatory effects, HIV affects the bones by disrupting new bone formation while also increasing the activity of proteins that drive the natural process of bone breakdown.

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Certain older HIV medications, particularly tenofovir disoproxil fumarate (TDF), can further impact bone loss by causing deficiencies in vitamin D and calcium in the bones, Chow says. Ultimately, this means that people with HIV have an increased risk of getting osteopenia (reduced bone density) or osteoporosis than those without HIV, and this risk is even higher for those taking TDF.

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“A lot of people are no longer using the older version of tenofovir,” Dr. Blumenthal says. “People are using tenofovir alafenamide now, which does not accumulate in the bones and does not cause that toxicity.”

Because of the impact of both HIV and certain HIV medications on the heart and bones, it’s important to be aware of which screenings you should be receiving, as well as what lifestyle modifications you can make to promote a healthy heart and bones.