References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
People living with HIV have approximately a 1.5-2 times higher risk of coronary heart disease compared to the general population. This elevated risk is driven by chronic inflammation from HIV, side effects of some antiretroviral drugs, higher rates of traditional risk factors, and accelerated aging of blood vessels.
Managing cardiovascular risk is an important part of long-term health with HIV. Most cardiovascular events are preventable with the right approach.
Why HIV Increases Heart Disease Risk
Chronic inflammation
Even well-controlled HIV on effective ART leaves persistent low-level inflammation in the body. This inflammation damages blood vessel walls, promotes atherosclerosis (plaque buildup), and increases the risk of blood clots.
ART side effects
Some antiretroviral drugs affect cardiovascular risk:
- Protease inhibitors (particularly older ones) can raise cholesterol and promote insulin resistance
- Abacavir has been associated with a small increase in cardiovascular events in some studies (debated)
- Weight gain from integrase inhibitors and TAF can contribute to cardiovascular risk
Traditional risk factors
People with HIV have higher rates of:
- Smoking
- High cholesterol
- Insulin resistance and diabetes
- High blood pressure
- Recreational drug use
How to Protect Your Heart
| Action | Impact |
|---|---|
| Stay on effective ART | Reduces HIV-related inflammation |
| Stop smoking | Single biggest impact on cardiovascular risk |
| Control cholesterol | Consider statins if elevated |
| Control blood pressure | Target below 140/90 (or lower with diabetes) |
| Exercise regularly | 150 minutes moderate activity per week |
| Healthy diet | Mediterranean-style diet reduces risk |
| Manage diabetes | If present, tight glucose control |
| Maintain healthy weight | Particularly important with modern ART |
| Limit alcohol | No more than 14 units per week |
Statins and HIV
Statins are effective for cardiovascular risk reduction but interact with some ART drugs. Important considerations:
- Simvastatin: Contraindicated with protease inhibitors and cobicistat
- Atorvastatin: Can be used with caution (dose reduction)
- Pitavastatin and pravastatin: Few interactions, often preferred for HIV patients
Your HIV specialist and GP will coordinate the safest choice.
Read more: HIV and cholesterol | HIV and stroke | What is HIV?
Frequently Asked Questions
Will my HIV treatment cause a heart attack?
Modern HIV treatment is much safer for cardiovascular health than older drugs. The overall benefit of effective ART (reducing inflammation, improving health) outweighs cardiovascular risks from specific drugs. Older protease inhibitors had more impact, but newer regimens are cardiovascular-friendly.
At what age should I worry about heart disease with HIV?
Cardiovascular events tend to occur 5-10 years earlier in people with HIV. Risk assessment and preventive measures should start earlier than for the general population. Discuss with your HIV specialist from around age 35-40.
Related reading
- A to Z of Sex: Sexual Health Terms Explained
- Alcohol and HIV: What You Need to Know
- Anxiety and HIV: Coping and Getting Support
- Are All STIs Curable?
- Blood Problems and HIV: Anaemia, Low Platelets and More
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
