Common infections may increase cardiovascular risk in HIV patients

L-R: Dr James McMahon, Dr Janine Trevillyan, Prof Jenny Hoy
and Dr Norm Roth (GP at Prahran Market Clinic) conferring. Jenny
and Janine are co-authors together with Victoria Berquist, a former
CCS BMedSc(Hons) student, on the paper on CV risk in HIV patients

by Anne Crawford

When human immunodeficiency virus (HIV) erupted more than 30 years ago, the lifespan of people with fully-blown AIDS was short. Management of the disease often meant palliative care.

Now, with effective drugs, the longevity of a person living with AIDS in Australia is approaching that of the general population. But there’s still a gap of some eight to 10 years lost over a lifetime, mostly due to heart attack and cancers. Monash University researchers at the Alfred Hospital are investigating the factors behind increased cardiovascular risk in HIV-positive individuals and what can be done to about them. 

Dr Janine Trevillyan, from the Department of Infectious Diseases, recently co-authored two papers (listed below) looking into common infections that may contribute to increased cardiovascular risk in HIV-positive individuals with Professor Jennifer Hoy and then Bachelor of Medicine student Tori Berquist.

Dr Trevillyan, currently based at UCLA on an Early Career Fellowship, said people with HIV were twice as likely to have a heart attack as the general population, taking into account other risk factors such as smoking and blood pressure.

The first paper, a review published in the journal ‘AIDS Reviews’ last month, found increasing evidence suggesting that a number of infections contribute to heart disease in people with HIV. Cytomegalovirus or CMV, a herpes family virus, periodontal disease and Hepatitis C, emerged as the main ones. The second paper looked specifically at periodontal disease or disease of the gums or mouth caused by bacteria.

“It makes sense to me, and other people, that HIV affects how our body controls other infection and we’re learning more and more about how those other infections drive heart disease risks,” Dr Trevillyan said.

“Until recently this had been poorly studied in HIV – that’s why we’re taking a real interest in looking at some of these infections in particular.”

Dr Trevillyan said the findings give the researchers data pointing to possible areas of intervention.

“Part of what we’re looking at doing now is to look at the treatment of periodontal disease, for instance, to see whether by being active about finding HIV patients who have problems with their teeth, and by treating this, it might reduce their chance of having a heart attack.”

The process would be similar with CMV: researchers could, for example, see if drugs specifically designed to counter CMV could help reduce cardiovascular risk.

The link to Hepatitis C wasn’t clear and more research was needed, Dr Trevillyan said. 

The researchers are now “piggy backing” clinical trials for new Hepatitis C drugs to investigate the link to heart attack further.

The second paper, on research into periodontal disease and cardiovascular disease, has been accepted and is expected to be published soon.

Dr Trevillyan, who returns to the Alfred next year, is also running trials with Professor Hoy and collaborators, based partly in Geneva, Switzerland, and partly at the Alfred, looking at whether statin therapy – antiflammatory, anti-cholesterol medication – can help people living with HIV.

Berquist V, Hoy JF, Trevillyan JM. Contribution of common infections to cardiovascular risk in HIV positive individuals. AIDS Rev. 2017 Feb 9;19(2). [Epub ahead of print]

Trevillyan JM, Gardiner EE, Andrews RK, Maisa A, Hearps AC, Al-Tamimi M, Crowe SM, Hoy JF. Decreased levels of platelet-derived soluble glycoprotein VI detected prior to the first diagnosis of coronary artery disease in HIV-positive individuals. Platelets. 2016 Nov 16:1-4.

See our interview with Victoria Berquist, co-author and former CCS BMedSc (Hons) student here