1. Remarks HIV and CVD Integration Peter Lamptey

2. 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

3. 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

4. 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

5. 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

6. 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

7. POLICY APPROACHES (Global; National; Local) Financial Trade Regulatory Legal Environment To Enable Individuals To Make and Maintain Healthy Choices INDIVIDUAL FAMILY NEIGHBORHOOD, COMMUNITY Enhancement of Knowledge, Motivation, and Skills of Individuals Media Settings Based Community Interventions HEALTH COMMUNICATION Preventive, Diagnostic, Therapeutic, Rehabilitative Services HEALTH CARE DELIVERY WIDER SOCIETY DETERMINANTS Globalization Access to Care Systems Infrastructure Health Workforce Quality of Care Drugs & Technologies Demographic Change Globalization Social Determinants Health Inequities Cultural and Social Norms Education Biological Risk Behavioral Risk

8. Integrated HIV/CVD Programs CVD risk assessment – behavioral & biomedical – CT – PMTCT – ART – Care and Support Management of CVD complications – ART – TB Surveillance

9. 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

10. Thanks