Studies of the effects of antiretroviral agents on cardiovascular disease risk are mixed. A literature review concluded that combination antiretroviral therapy has only a modest effect on increased cardiovascular risk (Aberg, 2009). The association of protease inhibitors with metabolic disturbances is complex—effects might be attributed to the specific drug and might not be applicable to the entire drug class. For example, indinavir and lopinavir-ritonavir have been shown to increase risk of myocardial infarction in 12 and 13 percent of patients, respectively (Worm et al., 2010), whereas the whole class of protease inhibitors was found to affect 16 percent of patients (The D:A:D Study Group, 2007). The nucleoside reverse transcriptase inhibitors abacavir and didanosine were also associated with an increased risk of myocardial infarction (Worm et al., 2010). One study found an increased risk of hypertension in patients taking nonnucleoside reverse transcriptase inhibitors as compared to HIV-positive patients not on antiretroviral treatment (Wilson et al., 2009).
Cardiovascular disease is a significant cause of disability among Americans and is covered by SSA’s Listing of Impairments under the Cardiovascular System (Listings 4.00 and 104.00). Cardiovascular disease is also a significant comorbidity of HIV infection. The committee concludes that HIV-infected claimants with disability due to cardiovascular disease should be considered under the Cardiovascular System Listings.
Chronic kidney disease includes HIV-associated nephropathy and end-stage renal disease (Gupta et al., 2005; Lucas et al., 2007; Szczech et al., 2004a; Winston et al., 2008). About 30 percent of HIV patients experience abnormal kidney functioning. Defined in Listing 6.00 as kidney damage or a glomerular filtration rate ≤ 60 mL/min for 3 or more months (National Kidney Foundation, 2002), chronic kidney disease can leave people at greater risk for faster progression to AIDS-defining illnesses and death (Szczech et al., 2004b). The disease is similar between seropositive and seronegative populations. Although the literature about the relationship between chronic kidney disease and HIV and its treatment is still developing, the incidence of chronic kidney disease appears to be slowing. Incidence of chronic kidney disease decreased significantly after the introduction of combination antiretroviral therapy. Although prevalence increased, this increase is potentially due to longer survival times (Lucas et al., 2007).
Chronic kidney failure is diagnosed through screening urine analysis, calculated estimates of renal function (e.g., creatinine clearance, glomerular filtration rate), and kidney biopsy. These tests are recommended by the Infectious Disease Society of America’s Guidelines for the Management of Chronic Kidney Disease in HIV-Infected Patients (Gupta et al., 2005).