Introduction:
The declining rate of HIV-related deaths has become rather slow in recent times, largely because of the rising incidence of cardiovascular events associated with the disease and its long-term treatment with anti-retroviral drugs. While conclusive evidences support the effectiveness of cardiovascular risk factor interventions in the general population, there is a dearth of such evidence of clinical effectiveness in certain high-risk subgroups, particularly HIV-infected patients on antiretroviral treatment.
Objective:
To evaluate the clinical effectiveness of risk factor interventions in preventing cardiovascular disease in HIV-positive patients on antiretroviral treatment (ART) and summarize the effect size.
Design and methods:
Systematic review of randomized controlled trials investigating the effects of interventions in modifying ART-associated risk factors for cardiovascular disease. Trials were eligible for inclusion if they were published in the last 12 years [2000 to June 2012] and participants were HIV-positive, on ART and having more than one ART-associated cardiovascular risk factor.
Results:
In total, 2,071 HIV-positive participants from 10 randomized trials were included in the review. The interventions evaluated comprised lifestyle modification, lipid-lowering treatment and smoking cessation. Overall, the main results showed significant improvements in total cholesterol [P<0.0001], LDL cholesterol [P<0.0001], HDL cholesterol [P<0.002], triglycerides [P<0.001], apolipoprotein B levels [P=0.036], adiposity [<0.001], anthropometry [P<0.001], insulin sensitivity [P<0.05], HbA1c levels [P<0.001], FBG levels [P=0.017], adiponectin levels [P<0.05], dietary intake [P<0.001], smoking abstinence [P<0.0001] and Framingham score [P=0.03].
The results also showed improvements in systolic [from 145.6±14.5 mmHg to 122.8±5.2 mmHg] and diastolic blood pressure [from 84.7±1.7 mmHg to 80.1±3.8 mmHg]; however, there was no improvement in carotid intima-media thickness [P=0.61] or inflammatory biomarkers [P=0.973 to 0.110].
Conclusion:
In conclusion, this review presents evidence suggesting that cardiovascular risk factor interventions are effective in HIV-infected persons on ART. However, cardiovascular screening programs targeting people living with HIV and primary studies assessing the effectiveness (clinical and cost) of multiple risk factor interventions in this sub-group are needed.
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