What is the issue for NSW?
People living with HIV have increased cardiometabolic risk from both the virus and their HIV treatments, with double the cardiac event rates of the general population. Cardiometabolic diseases are a group of common but often preventable conditions including heart attack, stroke, diabetes, insulin resistance and non-alcoholic fatty liver disease.
The World Health Organization recommends a certain class of anti-retroviral treatment due to its safety and effectiveness at treating HIV, however it also causes increases in bodyweight, blood pressure and risk of cardiovascular events. Currently there are few available treatments proven to reduce this risk and none are routinely recommended. People with HIV therefore continue to have unacceptable rates of cardiovascular events.
In addition, trials have tested expensive and hard-to-access medications to reduce cholesterol and vascular risk in people with HIV, however these are not accessible to the majority of people living with the virus. There is a need to test affordable and available cholesterol lowering alternatives for both safety and effectiveness.
What does the research aim to do and how?
This research will use a clinical trial to test two therapies in people with HIV taking anti-retroviral therapies known to increase metabolic risk. It will test whether a new cardiometabolic medication (called an SGLT2 inhibitor) can reduce bodyweight, blood pressure and other markers of cardiovascular risk in people with HIV, leading to less cardiovascular events. It will also test if cheap and available cholesterol medications are as effective and safe as the expensive and difficult to access cholesterol medications that have previously been studied in this population.
It will determine if these medications can reduce cardiometabolic risk in people with HIV.
The top three key measures/indicators being used to assess the research outcomes are:
- Change in cardiovascular risk markers (bodyweight and blood pressure)
- Change in cholesterol levels
- Change in cardiac fat and coronary artery plaque.