Aspirin Foundation Meeting 2013

Aiding treatment of HIV and cancer with aspirin

Dr Andrew Freedman - National Cancer Institute, Bethesda, USA

HIV, obviously it has been around for over thirty years now and we’ve now got very good treatment for HIV for treating the HIV itself. It has now become a chronic treatable condition rather like diabetes. People are no longer dying so much of the infectious complications of HIV but we are now seeing increasing morbidities from an aging cohort of patients and vascular disease has been found to be a particular problem amongst people with HIV. It’s multifactorial, it’s traditional risk factors like smoking and HIV patients do have a higher prevalence of smoking but in addition there seem to be effects from the virus itself – HIV does appear to increase vascular risk through various mechanisms, chronic inflammation particularly and probably effects on platelets as well although it hasn’t been fully worked out as yet. Because of that there’s increasing interest in performing vascular risk assessments on patients with long-standing HIV and obviously the effect of that should be to address risk factors where possible. Clearly aspirin, as primary prevention for both coronary artery problems and stroke is a logical step, however, no current guidelines actually recommend the use of aspirin specifically in HIV patients and there have been very few studies to date that have looked at that. There have been some retrospective studies looking at how often aspirin is being used in patients with significant cardiovascular risk and it does appear from these limited studies that it’s very much underutilised. There was one study in the States that showed only about 17% of patients who should have been on aspirin were actually being prescribed it. In fact, a more recent study has shown similar effects, slightly better, up to nearly 50% of patients with high cardiovascular risk receiving aspirin, but paradoxically the smokers amongst these patients were less likely to be prescribed aspirin. So I think there’s a long way to go, I think aspirin does need to be recommended for patients with HIV and high vascular risk. I’m sure it’s a promising way forward to reduce vascular disease.

There have been studies showing that HIV patients have an excess vascular risk, really not just the older patients who are obviously more likely to get vascular disease but younger patients, again quite significant increases over HIV negative patients, possibly even twice as high or more rates of vascular disease, heart attacks and strokes. So probably as patients get older up to 50% of patients probably would have a high enough cardiovascular risk. We use framing and risk assessment and most centres use that and they would qualify for aspirin. We do use statins probably more frequently than aspirin at the moment but I think we should be using both.

I’m not sure about every patient but certainly those at increased risk should be taking aspirin.