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I wonder how some of the more senior Faculty and Attendings would counsel me on how to address the following: HIV Associated Atherosclerosis, and the stigma many physician specialists view HIV, particularly Cardiologists, and hence not wanting to deal with this population.
An Infectious Disease Physician at the university has confided in me that HIV is perceived as a stigma by many medical specialists, going as far as telling me recently that there is a 'dark history' at my teaching hospital amongst Cardiologists in not wishing to see HIV patients. I had a second conversation with another ID Specialist at my university hospital and she agreed with the first one. The "justification" goes that HIV is an ID problem but the presentation is cardiac in nature - HIV Associated Atherosclerosis, principally non-calcified plaque, due to sub-acute levels of HIV in the undetectable patient initiating a persistent activation of cytokines and immune cells (monocytes, macrophages and T Cells) that result in non-calcified plaque in the coronary arteries. The pathophysiology is not quite understood. Please see the following recently published articles:
How to get both Physician Specialists (Cardiologists and ID Physicians) to take it upon themselves to be proactive with the HIV patient for CVD, and get over their stigma?
If any senior Attendings or other Fellows/Residents have encountered this problem, and addressed it, I'd like to learn about it.
I am charged with giving a presentation to a Cardiologist this Friday face to face at the university on why the Department needs to start taking a leadership role with this problematic population
I am up for the task but I am stunned any physician in this day and age would still harbor repulsion towards the HIV patient and not want to deal with them.
Thanks
An Infectious Disease Physician at the university has confided in me that HIV is perceived as a stigma by many medical specialists, going as far as telling me recently that there is a 'dark history' at my teaching hospital amongst Cardiologists in not wishing to see HIV patients. I had a second conversation with another ID Specialist at my university hospital and she agreed with the first one. The "justification" goes that HIV is an ID problem but the presentation is cardiac in nature - HIV Associated Atherosclerosis, principally non-calcified plaque, due to sub-acute levels of HIV in the undetectable patient initiating a persistent activation of cytokines and immune cells (monocytes, macrophages and T Cells) that result in non-calcified plaque in the coronary arteries. The pathophysiology is not quite understood. Please see the following recently published articles:
- HIV-1–Associated Atherosclerosis: Unraveling the Missing Link
- TMAO and HIV-Associated Atherosclerosi
- Persistent Immune Activation and Carotid Atherosclerosis in HIV-Infected Ugandans Receiving Antiretroviral
- HIV Infection Is Associated With Progression of Subclinical Carotid Atherosclerosis
- Coronary artery disease risk reduction in HIV-infected persons: a comparative analysis
In summary, when compared to demographically similar uninfected persons, HIV-infected persons treated in an HIV specialty clinic were less likely to be prescribed medications appropriate for CAD risk reduction. Improving primary preventative CAD care in HIV specialty clinic populations is an important step toward diminishing risk of heart disease in HIV-infected persons.
How to get both Physician Specialists (Cardiologists and ID Physicians) to take it upon themselves to be proactive with the HIV patient for CVD, and get over their stigma?
If any senior Attendings or other Fellows/Residents have encountered this problem, and addressed it, I'd like to learn about it.
I am charged with giving a presentation to a Cardiologist this Friday face to face at the university on why the Department needs to start taking a leadership role with this problematic population
I am up for the task but I am stunned any physician in this day and age would still harbor repulsion towards the HIV patient and not want to deal with them.
Thanks
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