F. Art Barnsworth
2012-06-18 22:52:30 UTC
By DONALD G. McNEIL Jr.
Mike Godfrey was 19 when he found out he had H.I.V.
He was 29 when he began antiretroviral therapy.
He was 43 when he had a heart attack.
I felt fluttery, he said. Weird and fluttery. It went away. I
ignored it. A week later, it came back, and this time I felt
something in my arm too. I was too stupid to call an ambulance.
I got in a cab and went to the hospital.
Mr. Godfreys experience exemplifies something a few AIDS
specialists have long suspected, and cardiologists have now
found evidence to support: People infected with H.I.V. have more
heart attacks and have them earlier in life. Even patients whose
infection is well suppressed by AIDS drugs are at higher risk.
Experts in the field said doctors need to be better informed
about this little-known threat to their H.I.V.-positive
patients. The threat also reinforces a message that public
health experts keep emphasizing: H.I.V. is no longer an
automatic death sentence, but it is still a dangerous disease.
I think most cardiologists and most H.I.V. specialists are not
really aware of this, said Dr. Priscilla Y. Hsue, a
cardiologist at San Francisco General Hospital who treats many
AIDS patients. Most of the people I see are referred to me
after theyve had a heart attack, a bypass, a stent. To me,
thats too late. We should be screening people for coronary
disease, aggressively treating blood pressure, aggressively
treating cholesterol.
People with H.I.V. have more than four times the risk of sudden
heart attack as their uninfected peers, Dr. Hsue and her
colleagues reported last month in The Journal of the American
College of Cardiology.
The most likely explanation is that both the virus and the drugs
that fight it cause chronic inflammation, said Dr. Paul M.
Ridker, a Harvard Medical School professor who led pioneering
studies that established the connection between inflammation and
heart disease. (He was not involved in the study published last
month.) Also, he said, the drugs cause the liver to make more
cholesterol, another heart attack risk factor.
While the link between H.I.V. and heart disease is not generally
known in the medical profession, some doctors who specialize in
the treatment of AIDS patients have long suspected such a
connection.
Ive had a number of patients men in their late 40s and early
50s who were just found dead at home, said Dr. Steven G.
Deeks, an AIDS expert at the University of California, San
Francisco, who was not involved in the study. Ive always
thought that was happening more than it should.
Both the virus that causes AIDS and other infections that can
accompany it can inflame tissues, he said. Inflammation can
produce blood clots, which can cause heart attacks. And in the
intestines, the virus can cause leaky gut syndrome, by which
other inflammatory microbes enter the bloodstream.
Dr. Zian H. Tseng, a heart rhythm specialist and a co-author
with Dr. Hsue of the new study, said he stumbled on the H.I.V.-
cardiac connection while he was doing a survey of every sudden
heart attack death in San Francisco and noticed that many
victims were taking antiretroviral drugs.
Initially, I thought it was just because of the high prevalence
of H.I.V.-positive people in San Francisco, but it was clearly
more than that, he said.
The researchers scoured the medical records of 2,860 patients
who were seen between 2000 and 2009 in Ward 86, San Francisco
Generals famous AIDS clinic. For those who had died, they
checked death certificates and paramedic reports and interviewed
doctors and family members, trying to see how many had had heart
attacks.
They acknowledged some limitations: Smoking and recreational
drug use are more common among people with H.I.V., and few of
the dead were autopsied. But all deaths that looked like
overdoses, suicides or assaults, as well as slow AIDS deaths,
were excluded.
There have been previous studies suggesting that people with
H.I.V. develop high cholesterol and blocked arteries about a
decade earlier than normal, but that is only now becoming widely
recognized.
I didnt know I had a heart problem until I had a heart attack
and a double bypass in 2003, said Mark Abramson, 59, author of
the Beach Reading series of gay mystery/romance novels.
Although he saw doctors and was intermittently taking AIDS
medication when he had medical insurance during his years as a
bartender, no one told me I was in a high-risk group.
He smoked and knew his blood pressure was a little high. He
did not remember any cholesterol tests.
Sharon Hampton, 57, had heart trouble first and only later
learned of a likely connection to the virus.
In her 30s, she developed high blood pressure and signs of
congestive heart failure. A self-professed workaholic, she
blamed the pressure of her job as a hospital claims processor.
Her physician advised her to find something less stressful; she
did for a while, but then moved to Sacramento and started
working at another hospital.
At age 45, she said, I had a heart attack right at my desk
thank God the E.R. was only seven feet away from the business
office.
After a quintuple bypass, she initially went back to work. But
her health deteriorated, and she has lived with family members
since.
Last Thanksgiving, after a health crisis hospitalized her, she
learned she had H.I.V.
I couldnt believe it, she said. I totally freaked out. I
thought it had to be a false positive. Ive been celibate for a
long time. I never had that lifestyle. Im afraid of drugs.
But when she was young, she said, she was briefly married to a
man she later learned injected drugs.
I just never knew, she said. He was Michelangelos David. I
was a country bumpkin.
She is apparently a rare elite suppressor, part of the 1 to 2
percent of the infected who, for unknown reasons, control the
virus without drugs. Although she has a nearly undetectable
viral load and no opportunistic infections, her doctors at
U.C.S.F. believe that the virus contributed to her heart
problems.
Jose Raneda, a 48-year-old former lawyer from Milwaukee, has
seen the thinking about the H.I.V.-heart connection change in
the last few years.
He has known he was infected since he was 21, started on AIDS
cocktails as soon as they were available, never had a low CD4-
cell count or an AIDS-related infection, and has always been
slim.
But he had his first of two heart attacks at age 40.
I asked my H.I.V. doctor if it was related, and he said it
wasnt, he said. I think he was mistaken.
His former physician, Dr. Ian H. Gilson of the Medical College
of Wisconsin, agreed.
At the time, we didnt have a lot of solid evidence of the
connection, he said. My thinking has evolved. Id tell him
something different now.
http://www.nytimes.com/2012/06/19/health/heart-attacks-are-much-
more-frequent-in-hiv-patients.html?pagewanted=all
Mike Godfrey was 19 when he found out he had H.I.V.
He was 29 when he began antiretroviral therapy.
He was 43 when he had a heart attack.
I felt fluttery, he said. Weird and fluttery. It went away. I
ignored it. A week later, it came back, and this time I felt
something in my arm too. I was too stupid to call an ambulance.
I got in a cab and went to the hospital.
Mr. Godfreys experience exemplifies something a few AIDS
specialists have long suspected, and cardiologists have now
found evidence to support: People infected with H.I.V. have more
heart attacks and have them earlier in life. Even patients whose
infection is well suppressed by AIDS drugs are at higher risk.
Experts in the field said doctors need to be better informed
about this little-known threat to their H.I.V.-positive
patients. The threat also reinforces a message that public
health experts keep emphasizing: H.I.V. is no longer an
automatic death sentence, but it is still a dangerous disease.
I think most cardiologists and most H.I.V. specialists are not
really aware of this, said Dr. Priscilla Y. Hsue, a
cardiologist at San Francisco General Hospital who treats many
AIDS patients. Most of the people I see are referred to me
after theyve had a heart attack, a bypass, a stent. To me,
thats too late. We should be screening people for coronary
disease, aggressively treating blood pressure, aggressively
treating cholesterol.
People with H.I.V. have more than four times the risk of sudden
heart attack as their uninfected peers, Dr. Hsue and her
colleagues reported last month in The Journal of the American
College of Cardiology.
The most likely explanation is that both the virus and the drugs
that fight it cause chronic inflammation, said Dr. Paul M.
Ridker, a Harvard Medical School professor who led pioneering
studies that established the connection between inflammation and
heart disease. (He was not involved in the study published last
month.) Also, he said, the drugs cause the liver to make more
cholesterol, another heart attack risk factor.
While the link between H.I.V. and heart disease is not generally
known in the medical profession, some doctors who specialize in
the treatment of AIDS patients have long suspected such a
connection.
Ive had a number of patients men in their late 40s and early
50s who were just found dead at home, said Dr. Steven G.
Deeks, an AIDS expert at the University of California, San
Francisco, who was not involved in the study. Ive always
thought that was happening more than it should.
Both the virus that causes AIDS and other infections that can
accompany it can inflame tissues, he said. Inflammation can
produce blood clots, which can cause heart attacks. And in the
intestines, the virus can cause leaky gut syndrome, by which
other inflammatory microbes enter the bloodstream.
Dr. Zian H. Tseng, a heart rhythm specialist and a co-author
with Dr. Hsue of the new study, said he stumbled on the H.I.V.-
cardiac connection while he was doing a survey of every sudden
heart attack death in San Francisco and noticed that many
victims were taking antiretroviral drugs.
Initially, I thought it was just because of the high prevalence
of H.I.V.-positive people in San Francisco, but it was clearly
more than that, he said.
The researchers scoured the medical records of 2,860 patients
who were seen between 2000 and 2009 in Ward 86, San Francisco
Generals famous AIDS clinic. For those who had died, they
checked death certificates and paramedic reports and interviewed
doctors and family members, trying to see how many had had heart
attacks.
They acknowledged some limitations: Smoking and recreational
drug use are more common among people with H.I.V., and few of
the dead were autopsied. But all deaths that looked like
overdoses, suicides or assaults, as well as slow AIDS deaths,
were excluded.
There have been previous studies suggesting that people with
H.I.V. develop high cholesterol and blocked arteries about a
decade earlier than normal, but that is only now becoming widely
recognized.
I didnt know I had a heart problem until I had a heart attack
and a double bypass in 2003, said Mark Abramson, 59, author of
the Beach Reading series of gay mystery/romance novels.
Although he saw doctors and was intermittently taking AIDS
medication when he had medical insurance during his years as a
bartender, no one told me I was in a high-risk group.
He smoked and knew his blood pressure was a little high. He
did not remember any cholesterol tests.
Sharon Hampton, 57, had heart trouble first and only later
learned of a likely connection to the virus.
In her 30s, she developed high blood pressure and signs of
congestive heart failure. A self-professed workaholic, she
blamed the pressure of her job as a hospital claims processor.
Her physician advised her to find something less stressful; she
did for a while, but then moved to Sacramento and started
working at another hospital.
At age 45, she said, I had a heart attack right at my desk
thank God the E.R. was only seven feet away from the business
office.
After a quintuple bypass, she initially went back to work. But
her health deteriorated, and she has lived with family members
since.
Last Thanksgiving, after a health crisis hospitalized her, she
learned she had H.I.V.
I couldnt believe it, she said. I totally freaked out. I
thought it had to be a false positive. Ive been celibate for a
long time. I never had that lifestyle. Im afraid of drugs.
But when she was young, she said, she was briefly married to a
man she later learned injected drugs.
I just never knew, she said. He was Michelangelos David. I
was a country bumpkin.
She is apparently a rare elite suppressor, part of the 1 to 2
percent of the infected who, for unknown reasons, control the
virus without drugs. Although she has a nearly undetectable
viral load and no opportunistic infections, her doctors at
U.C.S.F. believe that the virus contributed to her heart
problems.
Jose Raneda, a 48-year-old former lawyer from Milwaukee, has
seen the thinking about the H.I.V.-heart connection change in
the last few years.
He has known he was infected since he was 21, started on AIDS
cocktails as soon as they were available, never had a low CD4-
cell count or an AIDS-related infection, and has always been
slim.
But he had his first of two heart attacks at age 40.
I asked my H.I.V. doctor if it was related, and he said it
wasnt, he said. I think he was mistaken.
His former physician, Dr. Ian H. Gilson of the Medical College
of Wisconsin, agreed.
At the time, we didnt have a lot of solid evidence of the
connection, he said. My thinking has evolved. Id tell him
something different now.
http://www.nytimes.com/2012/06/19/health/heart-attacks-are-much-
more-frequent-in-hiv-patients.html?pagewanted=all