HHS Updates HIV Guidelines with New Focus on Cardiovascular adn Metabolic health
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The Department of Health and Human Services has released updated guidelines for HIV treatment, incorporating a dedicated chapter addressing the growing cardiovascular and metabolic health concerns facing individuals living with the virus.
The latest update to the Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV, released on September 25, reflects the evolving understanding of long-term health challenges for people with HIV. As advancements in antiretroviral therapy enable longer lifespans, a new focus is emerging on managing age-related comorbidities and the unique cardiovascular risks associated with the virus.
Rising Cardiovascular Risks in the HIV Community
Individuals living with HIV face a considerably elevated risk of atherosclerotic cardiovascular disease, approximately twofold higher than their HIV-negative counterparts.This risk is even more pronounced for HIV-positive women, where relative risk increases substantially. Current standard risk equations, however, often underestimate cardiovascular risk in this population, especially among women, highlighting the need for more tailored assessment tools.
“Optimal management of comorbidities (e.g., hypertension, diabetes, obesity) remains vital, but the guidelines do not recommend altering antiretroviral regimens solely to reduce immune activation or inflammation, except within the context of clinical trials. Similarly, the routine use of immunomodulatory or anti-inflammatory therapies and monitoring of biomarkers for these conditions are not advised at this time.”
Weight Gain and emerging Therapies
Weight gain is an increasingly recognized concern among people living with HIV, though studies exploring the connection to antiretroviral therapy have yielded mixed results.The guidelines emphasize that treatment should not be delayed, interrupted, or altered solely to manage weight. Instead, clinicians should prioritize weight monitoring and counseling as part of extensive care, with lifestyle modification – including healthy eating and regular exercise – remaining the cornerstone of weight management.
The guidelines also touch upon the potential of GLP-1 agonists – such as semaglutide (Wegovy or Ozempic) and tirzepatide (Zepbound or Mounjaro) – which have shown promise in early studies for reducing inflammation, improving cognitive function, and even slowing biological aging in people with HIV. The SLIM LIVER trial,for example,found that semaglutide reduced liver fat by approximately 30% in HIV-positive individuals with metabolic dysfunction-associated steatotic liver disease (MASLD).In August,the food and drug administration approved Wegovy for the treatment of metabolic dysfunction-associated steatohepatitis (MASH),a more advanced form of fatty liver disease,based on research involving HIV-negative individuals.
Broader Updates and Cost Considerations
Beyond cardiovascular and metabolic health, the updated guidelines include revisions to sections covering laboratory testing, viral load and CD4 count monitoring, initiation of antiretroviral treatment, and management of suboptimal CD4 cell recovery.
Recognizing the challenges within the U.S. healthcare system, the guidelines also address the impact of cost considerations on adherence to antiretroviral therapy. Disengagement from care is more frequent during transitions – such as moving from pediatric to adult care, release from incarceration, or changes in insurance coverage, including transitioning to Medicare. “the complexities of the U.S. health care system may require that the costs for antiretroviral therapy…be one of the considerations in regimen selection, in this very way expenditures can directly affect affordability and adherence,” the authors wriet. Changes to insurance coverage can lead to lapses in viral suppression and should be proactively anticipated.
These updated guidelines represent a crucial step in addressing the evolving health needs of individuals living with HIV, emphasizing a holistic approach that extends beyond viral suppression to encompass long-term cardiovascular and metabolic well-being.
