Bengaluru — Medical experts gathered here have issued a strong call for cardiovascular care to be systematically integrated into long-term HIV treatment protocols, warning that people living with HIV face elevated and sustained risks of heart disease that extend far beyond the acute phase of infection.
Speaking at a medical forum in the city, cardiologists and infectious disease specialists presented evidence that HIV accelerates cardiovascular aging through chronic inflammation, persistent immune activation, and the metabolic effects of long-term antiretroviral therapy. They argued that cardiac risk assessment, lipid monitoring, and lifestyle counselling should become routine components of HIV care, alongside established priorities such as viral load testing and opportunistic infection management.
The specialists noted that cardiovascular disease has emerged as a leading non-communicable cause of death among patients on long-term antiretroviral therapy, particularly in populations where treatment access has expanded significantly over the past two decades. Traditional cardiovascular risk factors, they said, are compounded by HIV-specific mechanisms, including persistent immune dysregulation and drug-related changes in cholesterol and glucose metabolism.
“We are seeing a demographic shift in HIV care that we must urgently address,” said one participating cardiologist. “Patients who were once dying of AIDS-defining illnesses are now living normal lifespans, but with a different risk profile that our current treatment frameworks do not adequately address.”
The forum brought together clinicians from multiple specialties who emphasized that cardiac screening should not be treated as an optional add-on to HIV care but as an essential component of comprehensive treatment. Beyond medical management, the specialists called for structured screening protocols, expanded training for HIV clinicians in basic cardiovascular assessment, and clearer referral pathways to cardiology services.
They also urged greater attention to modifiable lifestyle factors such as smoking cessation, dietary modifications, and physical activity — areas that often receive limited focus in resource-constrained HIV clinics focused primarily on infectious disease management.
The call reflects a broader shift in global HIV medicine from a singular focus on viral suppression toward a more holistic model of long-term health maintenance. As life expectancy for people living with HIV has risen substantially due to advances in antiretroviral therapy, non-communicable diseases now account for a growing share of mortality in this patient population. The experts’ framing suggests that treating HIV as a chronic condition requires the same chronic-disease infrastructure used for conditions like diabetes or hypertension, including continuous risk monitoring rather than episodic intervention.
“What we are proposing is not a new specialty but an expansion of the existing framework,” said an infectious disease specialist at the forum. “HIV clinicians already manage chronic conditions. We are simply asking them to extend that expertise to cardiovascular risk.”
Analysis:
The consensus among experts at the Bengaluru forum points to a significant gap in current HIV care guidelines, which have historically concentrated on infectious complications and have only recently begun to formally address cardiovascular comorbidities. The discussion highlighted that while global health organizations have increasingly acknowledged the link between HIV and cardiovascular disease, implementation at the national and state level remains inconsistent.
India’s national antiretroviral programme has expanded substantially over the past two decades, providing treatment to millions of people living with HIV. The country’s National AIDS Control Organisation has overseen a dramatic reduction in HIV-related mortality, but experts argue that the success of this programme now creates new challenges as patients live longer and face age-related health conditions.
The proposal to integrate cardiac care into HIV treatment raises practical questions about healthcare infrastructure, training requirements, and resource allocation. Specialists have not yet detailed comprehensive cost estimates for implementing the suggested changes, but they emphasized that early detection of cardiovascular risk could reduce long-term hospitalization and treatment costs associated with advanced heart disease.
For India’s healthcare system, which already operates under significant resource constraints, the integration of cardiovascular screening into HIV clinics would require coordination between the National Programme for Prevention and Control of Non-Communicable Diseases and state AIDS control societies. Whether cardiac screening becomes a standard protocol will likely depend on national guideline revisions, funding allocations, and the willingness of various government health programmes to coordinate services.
The timing of this discussion comes as cardiovascular disease rates rise across India more broadly, driven by changing dietary patterns, reduced physical activity, and other lifestyle factors. People living with HIV face compounded risks that make them particularly vulnerable to these broader trends.
What to Watch Next
Healthcare policymakers and advocacy groups will be watching closely for any response from NACO and state AIDS control societies to the recommendations emerging from the Bengaluru forum. National guideline revisions typically follow extended consultation periods, and any changes to standard HIV care protocols would require buy-in from clinicians across multiple specialties.
Funding considerations will be critical. The Indian government’s health budget faces competing demands, and integrating cardiac screening into HIV clinics would require both equipment investments and human resource training. International organizations that support India’s HIV programme, including the Global Fund and UNAIDS, may play a role in funding pilot initiatives.
Research priorities could also shift as a result of this discussion. Several Indian medical institutions have ongoing studies examining cardiovascular outcomes in people living with HIV, and their findings could provide the evidence base needed to justify guideline changes. Data on the prevalence of cardiovascular disease among India’s HIV-positive population remains limited, which specialists identified as a barrier to policy development.
Training programmes for HIV clinicians represent another area to monitor. Medical education in India has traditionally separated infectious disease and cardiovascular medicine, and bridging that gap would require curriculum changes and continuing medical education initiatives.
Broader Implications
The Bengaluru forum’s recommendations align with evolving global health perspectives on HIV care. The World Health Organization has progressively expanded its guidance on HIV management to include non-communicable disease considerations, reflecting the changing demographics of the HIV-positive population worldwide.
For patients themselves, the integration of cardiac care into HIV treatment could fundamentally change their healthcare experience. Many people living with HIV already navigate multiple specialists and fragmented care, and a more coordinated approach could reduce administrative burdens while improving health outcomes.
Advocacy organizations representing people living with HIV have generally welcomed the discussion, though they caution that any changes must be implemented in ways that do not stigmatize patients or create additional barriers to treatment access. The balance between comprehensive care and maintaining a welcoming, non-judgmental clinical environment will be important to consider.
As India’s HIV programme enters its next phase, the question of how to manage non-communicable disease risks in an aging patient population moves from an academic discussion to an urgent policy consideration. The experts gathered in Bengaluru have laid out their recommendations clearly. The response from health authorities will determine whether those recommendations translate into changed practices for the millions of Indians living with HIV.
Sources
[The Hindu](https://www.thehindu.com/news/national/karnataka/cardiac-care-must-become-integral-to-long-term-hiv-treatment-say-experts/article71405801.ece)
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Story synopsis gathered from: The Hindu – National — source
