Remarks

HIV and CVD IntegrationPeter Lamptey

Rationale for CVD/HIV Integration

• HIV and CVD synergies– HIV effects on CVD risk factors– HAART effects on CVD– HIV and tobacco smoking

• CVD risk factors and TB• Sharing lessons learned in HIV and CVD• Health systems strengthening – opportunities for

integration

HAART Effects on CVD*

• Dyslipidemia– Increased LDL cholesterol– Increased triglycerides– Increased total cholesterol– Decreased HDL cholesterol

• Increased insulin resistance• Body fat distribution• Diabetes*Significant but low risk of CVD event compared to benefits of HAART

HIV Direct Effects on CVD Risk Factors

• Uncontrolled HIV results in metabolic and inflammatory events that increase CVD risk:– Increased triglycerides– Decreased HDL cholesterol– Increased insulin resistance

HIV and Tobacco Smoking

• Higher prevalence of smoking in HIV-infected individuals

• Smoking may be associated with:– Poorer outcomes in HIV– Increased risk of TB and other OI’s– Lower adherence to HAART– Reduction in efficacy of HAART

CVD Risk Factors and TB

• Tobacco smoking associated with:– Increased risk of TB infection– Increased conversion from latent to active TB– Poorer treatment outcomes– Increased drug resistance– Increased rate of relapse– Increased mortality – x4 in smokers in India

• Relationship between TB and diabetes– Diabetes associated with x3 fold increase of TB– TB contributes to the risk of developing diabetes

POLICY APPROACHES(Global; National; Local)

FinancialFinancial TradeTradeRegulatoryRegulatoryLegalLegal

Environment To Enable Individuals To Make and Maintain Healthy Choices

INDIVIDUAL

FAMILY

NEIGHBORHOOD, COMMUNITY

Enhancement of Knowledge, Motivation, and Skills of Individuals

MediaMedia Settings BasedSettings BasedCommunity InterventionsCommunity Interventions

HEALTH COMMUNICATIONP

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Demographic Change

Globalization

Social Determinants

Health Inequities

Cultural and Social Norms

Education

Biological Risk

Behavioral Risk

Integrated HIV/CVD Programs

• CVD risk assessment – behavioral & biomedical– CT– PMTCT– ART– Care and Support

• Management of CVD complications– ART– TB

• Surveillance

Strengthening Systems for Health

• Policy, leadership, governance• Human resources• Supply chain management – drugs, other commodities• Information management – HMIS, SI, QI etc• Health care financing• Health services – public, private, civil society• Inter-sectoral capacity

Thanks