Metabolic Health

High blood pressure, also known as hypertension, occurs when the pressure inside the arteries is frequently or permanently higher than it should be. For most people, this means higher than 140/90 mmHg. Your blood pressure is usually controlled by your nervous system, heart, kidneys, and various hormones. In certain circumstances (e.g. while exercising) it is normal for your blood pressure to increase temporarily. However, when the blood pressure remains elevated for prolonged periods of time, this can cause damage to blood vessels, your heart, and other organs.

High blood pressure becomes more common as people get older, affecting 30-40% of Australian adults over the age of 18 years old. For most people, this results from a combination of genetics, and hardening of the arteries. However, other factors can increase your blood pressure, including stress, excess of certain hormones (e.g. thyroid hormones, cortisol, testosterone), certain blood conditions, and kidney disease.

Importance for PLHIV50+

All people living with HIV should have their blood pressure checked each visit to your healthcare professional or at least annually , as hypertension usually causes no symptoms, unless particularly high. Over time, unmanaged high blood pressure can lead to damage to the circulatory system, increasing your risk of heart attack, stroke, and other complications.

People living with HIV are at higher risk of high blood pressure, particularly as they get older. Detecting and controlling hypertension is an important modifiable risk factor to reduce the risk of heart disease and stroke.

Management strategies

Managing your blood pressure with your healthcare professional can involve a combination of lifestyle factors, and medications. The first thing you can do is to lead a healthy lifestyle through diet and exercise. Eating a low-fat diet that is rich in fruit and vegetables, reducing your salt intake, and cutting down on alcohol can all reduce blood pressure. Exercise is also important – try to exercise for at least 30 minutes on most days of the week and reduce the amount of time spent sitting. Of course, taking medications as prescribed by your healthcare provider is also  important in reducing your blood pressure and its complications.

The British HIV Association (BHIVA) has recommended that everyone living with HIV aged 40 and over should take a statin to reduce their risk of heart disease, even if they do not have raised cholesterol or a high risk of heart disease. This new advice is in response to the results of the REPRIEVE study, presented at the International AIDS Society Conference on HIV Science in July 2023. The study showed that taking a prescribed statin daily reduced the risk of a major cardiovascular event such as heart attack, stroke or a clinical intervention to treat a serious heart disorder by 35% in people with HIV. Crucially, the study only recruited people with a low-to-moderate risk of serious heart disease.

Glucose is a type of sugar and an important fuel for the body. High blood glucose levels can be harmful, however. The level of glucose in the blood is usually controlled by insulin, produced in the pancreas, and other hormones. Diabetes mellitus, “diabetes”, is a group of medical conditions that occur when the body is either unable to produce enough insulin or does not respond to the effects of insulin properly. The end result is higher than normal blood glucose levels.

Often having high blood sugar level causes no symptoms. When symptoms do occur, they can include needing to urinate often, excessive thirst, tiredness, and blurred vision. If not treated, it can increase the risk of heart attack, stroke, and kidney disease. It can also affect your sight, or lead to blindness, affect the sensation of your hands and feet, and lead to infections.

Importance for PLHIV50+

People living with HIV (PLHIV) are approximately twice as likely to get diabetes when compared with the rest of the population. While genetics plays an important role, lifestyle factors, including physical activity, obesity, and nutrition are important. Some medications used in the treatment of HIV may impact the risk for diabetes.

To find out if you have diabetes, your healthcare provider can do a blood test to check your blood sugar levels. The test might be normal, confirm diabetes, or indicate that you have “prediabetes” (also called “impaired glucose tolerance” or “impaired fasting glucose”). Prediabetes is a golden opportunity to reduce your risk of progressing to diabetes. Modest weight reduction, and lifestyle change can halve the risk of progression.

Management strategies

If you have diabetes there are a few things you can do to improve you blood sugar levels and even control diabetes. Modest weight reduction, achieving a healthy waist circumference, increasing physical activity, and improving your diet are all important management strategies for diabetes. Despite these, people often need medications to help lower their blood glucose, and sometimes need insulin injections. These are many treatments available now, which your doctor or endocrinologist (diabetes specialist) can prescribe.

HIV-associated Cardio Vascular Disease (CVD) is the result of complex interactions between traditional cardiovascular risk factors, side effects of ART and the chronic inflammation and immune activation associated with long term HIV infection. It is important to acknowledge, however, that the assessment and management of traditional CVD risk factors is still the cornerstone of clinical practice and should be prioritised among people with HIV infection on at least an annual basis.

Importance for PLHIV50+

It is important to have your Cholesterol and Triglycerides checked at least annually as they usually cause no symptoms, unless particularly high. Over time, unmanaged Cholesterol and Triglycerides can lead to damage to the circulatory system, increasing your risk of heart attack, stroke, and other complications.

People living with HIV (PLHIV) are at higher risk, particularly as they get older. HIV positive women appear to be disproportionately at increased risk of CVD. While absolute CVD rates remain low in women, HIV infection increases the baseline risk twice as much in women with HIV infection than it does in men with HIV infection. It is important to highlight that CVD and all-cause mortality is overall dramatically decreased by Anti-Retroviral Therapy.

Management strategies

Managing your Cholesterol and Triglycerides with the help of your healthcare professional can involve a combination of lifestyle factors, and medications. The first thing you can do is to lead a healthy lifestyle through diet and exercise and stop smoking. Eating a low-fat diet that is rich in fruit and vegetables, reducing your salt intake, and cutting down on alcohol. Exercise is also important – try to exercise for at least 30 minutes on most days of the week, and reduce the amount of time spent sitting. Taking Statin medication, as prescribed by your healthcare provider is really important to reducing Cholesterol and Triglycerides. A recent study has also shown that a daily statin medication can be used as a preventative measure even if you don’t have high cholesterol and triglycerides. Speak to your health care professional about this new development.

The kidneys are important for maintaining the body’s balance of fluid and salts, and filtering toxins from the body. They also help to regulate blood pressure, encourage the production of red blood cells, and bone health.

Chronic kidney disease occurs when one of two things happen: they aren’t able to filter the blood properly; or they are structurally damaged. You can lose up to 90% of your kidney function before you get any symptoms. It usually develops slowly, and affects 5-10% of people living with HIV (PLHIV).

Importance for PLHIV50+

PLHIV are more likely to develop chronic kidney disease than the general population, and it is becoming more common as PLHIV get older. This may be directly related to HIV infection or previous or current antiviral medications. Often it is related to other medical problems, like diabetes, high blood pressure, viral hepatitis, kidney stones, or infections. Sometimes people ultimately might require dialysis or a kidney transplant.

Diagnosis

It is important to detect kidney disease early to prevent it from getting worse and to minimise further complications. PLHIV usually have their kidney function checked at least twice per year, and a urine test for protein at least once per year. This is usually done alongside normal blood tests with your healthcare provider.

If kidney disease is present, you might be referred to a kidney specialist. Careful management of your blood pressure, HIV, and diabetes, in conjunction with your healthcare provider, are important to optimise your kidney health.