BOX 6-1

List of HIV-Associated Conditions With Current Listings Elsewhere in the Listing of Impairments

HIV-associated conditions that have current listings in the Listing of Impairments, not covered in the HIV Infection Listings, include the following, but are not limited to:

  • Cardiovascular disease;

  • Chronic kidney disease, including HIV-associated nephropathy;

  • Diabetes;

  • Hepatitis; and

  • Malignancies, not otherwise specified in the report.

Cardiovascular Disease

An increased risk for cardiovascular disease in HIV-infected populations as compared with HIV-negative populations has been well documented (Currier et al., 2008). Cardiovascular disease is the leading cause of death of Americans. It is also a leading cause of death in those infected with HIV, with an analysis of the Data Collection on Adverse Events of Anti-HIV Drugs Study finding that 11 percent of HIV-positive people die from a cardiovascular condition (Smith and the D:A:D Study, 2009). The risk factors for cardiovascular disease in HIV-infected populations are the same as those in the general population, including smoking, older age, diabetes, male gender, and other prior cardiovascular conditions (Currier et al., 2008; Glass et al., 2006). Increasingly, HIV infection itself is considered a cardiovascular disease risk factor, probably as or more important than the conventional ones.

The exact mechanisms and extent of the relationship between HIV and cardiovascular disease are not well understood. Hypotheses suggest increased cardiovascular disease can be related to HIV infection and, to a lesser extent, combination antiretroviral therapies. A review of cohort studies indicated that HIV-infected adults are at higher risk of cardiovascular disease than adults without HIV (Currier et al., 2008). The presence of HIV can lead to changes in lipid profiles that are themselves cardiovascular disease risk factors, such as low HDL-C and high triglyceride levels (Aberg, 2009). HIV is also implicated in chronic inflammation, which can be a cause of endothelial dysfunction, a risk factor for atherosclerosis (de Saint Martin et al., 2007). While the risk of developing cardiovascular disease is elevated in conjunction with HIV infection, the disease profile and impact on disability is similar to that in uninfected individuals.

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