Life with HIV after angioplasty at 59

Question

I have been HIV positive for almost 25 years (that I know of); the first 9 years without treatment. Last June I had a hearth attack requiring angioplasty in 2 arteries (100% blockage and 85% blockage). In december 2009 test showed poor irrigation of a portion of my hearth, so last week I had my arteries examined again and the installation of another stent as I had another blockage (65%) in the same arteries as one stented in June. My blood pressure, my cholesterol, have been good for the last 5 years after a period of difficulty with cholesterol while on other medication (Kaletra mostly). I am also fit, did cardio exercise daily until the hearth attack, and I am not overweight. I read that the blockage is either due to the medication (abacavir) or the period of untreated HIV and I understand that all is not clear on those topics. My question is what does the future hold for me if plaque keep building up in my arteries at a rate requiring angioplasty every 8 months? Again My cholesterol is controlled, I still train daily, am not overweight, so what else can I do? How many stent can one have? am I heading towards by-pass surgery? For the first time, I feel that HIV is about to get me soon throught hearth problems.

Answer

Abacavir may contribute to cardiac risk in some patients so switching off to tenofovir may be an option if your renal function is OK. Genetics, family history, smoking, renal dysfunction are all important non-HIV risk factors that can play a key role. I have had patients who developed severe heart disease with actual heart attacks who have undergone angioplasties/stenting, and by pass surgery and have done fine for > 10 years with quality health so it can be done but obviously needs intense effort to control all factors that can be managed (sounds like you are doing much of that already). Sometimes seeing a preventative cardiologist or endocrinologist can be useful for ideas how to manage risk. KH