Cardiovascular disease is of particular concern in people with HIV infection – with at least twice the risk of ischaemic heart disease and heart failure compared to non-HIV patients, even in the context of HIV viral suppression.^[8] The rates of stroke, and other CVD manifestations, including pulmonary hypertension and sudden cardiac death are also higher.  The increased risk of CVD and other atherosclerotic vascular disease can be associated with, or a direct consequence of, using some antiretroviral drugs as well as a result of the high and increasing prevalence of traditional risk factors for CVD (smoking, hypertension, dyslipidemia, diabetes, recreational drug use) – see section of this website on: Atherosclerotic vascular disease in people with HIV infection.

Guidelines for the screening of people with HIV infection for CVD follow recommendations for the general population, with a focus on obtaining virologic suppression and appropriately managing traditional risk factors. ^[4] Cardiovascular disease risk calculators, including the Framingham risk score often underestimate the risk of CVD in people with HIV infection. ^{[4, 76]}.

Key recommendations

1. Screen for CVD in all age-appropriate people with HIV infection; in particular those with traditional CVD risk factors
2. CVD risk prediction tools used in the general population may underestimate the risk of CVD in people with HIV infection.
3. Strongly encourage smoking cessation in all older people with HIV infection.
4. If possible, avoid ART regimens that include abacavir or boosted protease inhibitors (except atazanavir) in older people with HIV infection and increased CVD risk.