Effective Strategies for Managing Cardiometabolic Challenges in HIV

Introduction to Cardiometabolic Issues in HIV

The advent of highly active antiretroviral therapy (HAART) has significantly transformed the landscape of HIV treatment and management. With improved life expectancy among individuals living with HIV (PLHIV), there is an increasing recognition of cardiometabolic complications associated with chronic HIV infection and its treatment. Cardiometabolic disorders, which encompass conditions such as cardiovascular disease, diabetes mellitus, and metabolic syndrome, have emerged as prevalent health challenges in this population.

A multitude of factors contributes to the heightened incidence of cardiometabolic issues in PLHIV, including chronic inflammation, immune activation, antiretroviral therapy (ART)-related metabolic effects, and lifestyle changes (Mugisha et al., 2025). Despite the effectiveness of ART in managing HIV viral loads, PLHIV remain at a substantially elevated risk for cardiovascular diseases compared to the general population, necessitating a focused approach to managing their cardiometabolic health.

Importance of Early Detection and Screening for Cardiometabolic Disorders

Early detection and routine screening for cardiometabolic disorders are critical components of comprehensive care for PLHIV. Studies indicate that routine assessment of cardiometabolic risk factors can lead to timely interventions that significantly improve long-term health outcomes (Ghanem et al., 2025). The European AIDS Clinical Society (EACS) recommends regular monitoring of blood pressure, lipid levels, and glucose metabolism for individuals on long-term ART (Mugisha et al., 2025).

Screening for conditions such as hypertension, dyslipidemia, and insulin resistance should be integrated into regular HIV care routines. For instance, the Framingham Risk Score and ASCVD Risk Calculator are valuable tools that can be employed to quantify cardiovascular risk in PLHIV, allowing for the tailoring of prevention strategies (Ghanem et al., 2025).

Table 1: Recommended Screening Protocols for Cardiometabolic Disorders in PLHIV

Cardiometabolic Component	Screening Protocol	Diagnostic Criteria
Blood Pressure	Measure at every clinic visit	≥130 mmHg systolic or ≥85 mmHg diastolic
Lipid Profile	Annual fasting lipid panel	Triglycerides ≥150 mg/dL, HDL cholesterol <40 mg/dL (men), <50 mg/dL (women)
Glucose Metabolism	Fasting plasma glucose every 1-3 years	Fasting plasma glucose ≥100 mg/dL; physician-diagnosed diabetes
Body Mass Index (BMI)	Calculate at every visit	BMI ≥30 kg/m² indicates obesity

Evidence-Based Management Strategies for Cardiometabolic Health

Management of cardiometabolic disorders in PLHIV should be approached through a combination of lifestyle modifications, pharmacological interventions, and optimization of ART regimens. Evidence suggests that lifestyle interventions, including dietary changes and increased physical activity, play a pivotal role in mitigating cardiometabolic risks (Woldu et al., 2020).

Lifestyle Modifications

Dietary Changes: Encouraging PLHIV to adopt a diet rich in fruits, vegetables, whole grains, and lean proteins can improve overall metabolic health. Specific recommendations include:
- Increased consumption of omega-3 fatty acids from fish sources.
- Reduction of saturated fats and sugars.
Physical Activity: Regular exercise is essential for managing weight and improving cardiovascular health. Aiming for at least 150 minutes of moderate-intensity aerobic activity each week can provide substantial benefits.

Pharmacological Interventions

Pharmacological management may include the use of antihypertensive medications, statins for dyslipidemia, and glucose-lowering medications for diabetes management. Recent studies have indicated that statins can reduce cardiovascular events among PLHIV, despite the ongoing management of HIV itself (Woldu et al., 2020).

Optimization of ART Regimens

Choosing ART regimens that are less likely to induce metabolic side effects is critical. Certain ART classes, particularly integrase strand transfer inhibitors (INSTIs), have been associated with more favorable metabolic profiles, making them preferable options for individuals at high risk for cardiovascular disease (Mugisha et al., 2025).

Role of Antiretroviral Therapy in Cardiometabolic Outcomes

ART plays a dual role in the management of HIV and its associated cardiometabolic complications. While effective viral suppression through ART is essential for reducing HIV-related morbidity, some ART regimens can exacerbate cardiometabolic issues. For example, protease inhibitors have been linked to dyslipidemia and insulin resistance, necessitating careful selection of ART in patients with pre-existing metabolic conditions (Mugisha et al., 2025).

Table 2: Impact of Common ART Classes on Cardiometabolic Health

ART Class	Impact on Cardiometabolic Health
Protease Inhibitors	Associated with increased cholesterol and triglyceride levels; insulin resistance
NRTIs (e.g., Zidovudine)	May cause lipoatrophy and metabolic syndrome
INSTIs (e.g., Dolutegravir)	Generally neutral or beneficial effects on lipid profiles

Collaborative Approaches to Improve Patient Outcomes in HIV Care

Collaboration among healthcare providers, patients, and community resources is paramount to achieving optimal cardiometabolic health among PLHIV. Interdisciplinary care teams that include primary care physicians, endocrinologists, dietitians, and mental health professionals can address the multifaceted needs of this population effectively.

Patient Education and Engagement

Engaging patients in their care through education can enhance adherence to treatment and lifestyle recommendations. Support groups and community resources can provide additional layers of support, helping patients navigate the complexities of managing both HIV and cardiometabolic health.

Policy and System-Level Approaches

At the policy level, there is a need for healthcare systems to prioritize integrated care models that address both HIV management and cardiometabolic health. This could involve the development of standardized care pathways that ensure routine screening and management of cardiometabolic disorders in HIV clinics.

Conclusion

In summary, managing cardiometabolic challenges in individuals living with HIV requires a comprehensive approach that encompasses early detection, evidence-based management strategies, and collaborative care models. By implementing routine screening protocols and optimizing treatment regimens, healthcare providers can significantly improve health outcomes and quality of life for PLHIV.

FAQ

Why are PLHIV at greater risk for cardiometabolic disorders?

PLHIV are at greater risk due to factors such as chronic inflammation, immune activation, and potential side effects from certain antiretroviral therapies.

What lifestyle changes can help manage cardiometabolic health in PLHIV?

Adopting a balanced diet, increasing physical activity, and avoiding tobacco use are crucial lifestyle changes that can help manage cardiometabolic health.

What role does ART play in managing cardiometabolic complications?

ART is essential for controlling HIV viral loads but should be carefully selected to minimize potential adverse effects on metabolic health.

How important is early detection of cardiometabolic disorders in PLHIV?

Early detection through routine screening is vital as it allows for timely interventions that can prevent serious complications and improve long-term health outcomes.

What collaborative strategies can enhance care for PLHIV?

Interdisciplinary collaboration among healthcare providers, patient education, and community support resources can enhance care and improve outcomes for PLHIV.

References

Mugisha, N., Ghanem, L., Komi, O. A. I., Noureddine, R., Shariff, S., Wojtara, M., Nanehkeran, M. M., & Uwishema, O. (2025). Addressing Cardiometabolic Challenges in HIV: Insights, Impact, and Best Practices for Optimal Management—A Narrative Review. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12007417/
Woldu, M., Minzi, O., & Engidawork, E. (2020). Prevalence of Cardiometabolic Syndrome in HIV-Infected Persons: A Systematic Review. Journal of Diabetes & Metabolic Disorders, 19(2), 1671-1683. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33553042/
Ghanem, L., & Uwishema, O. (2025). Cardiovascular Disease and HIV Infection. Current HIV/AIDS Reports, 10(3), 199-206. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23793823/