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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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WIDER SOCIETY
DE
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Globalization
Ac
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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