How to Protect Your Heart and Bone Health While Taking ART for HIV
Published on October 16, 2026
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Thanks to modern antiretroviral therapy (ART), people with HIV are living long lives on par with those of the general population. With this longer life expectancy comes more age-related issues like heart disease and bone loss.
Heart disease and bone loss are more common among people with HIV because chronic, low-level inflammation from HIV, on top of long-term use of certain HIV medications, can affect your heart and bones over time. But regular, proactive medical screenings combined with simple daily lifestyle habits can help keep your cardiovascular and skeletal systems strong for years to come.
How HIV and HIV Medications Affect Your Heart and Bones
HIV causes increased immune response and inflammation that persists at lower levels even when the virus is well controlled. This increases your risk for a range of chronic conditions, including cardiovascular disease and osteoporosis (weakened bones). If you’re on certain older HIV medications, your risk for heart and bone issues is even greater, but don’t change or stop taking any prescription medications, including your ART, without speaking with your healthcare provider first.
HIV and the Heart
Compared with the general population, people with HIV have higher rates of heart attack, heart failure, and sudden cardiac death because of the ways HIV affects the heart. “It could be a heart muscle issue, a blood clotting issue, or a timing issue with the heart itself,” says Dominic Chow, MD, PhD, MPH, a professor with the Hawai’i Center for AIDS and the University of Hawai’i Department of Medicine.
"The way I really think of it, and the way I explain it to patients, is that HIV is a risk factor for cardiovascular disease,” similar to having a family history for it, smoking, or living a sedentary lifestyle, adds Jill Blumenthal, MD, an infectious-disease specialist with UC San Diego Health.
Research also suggests that certain older HIV medications can increase your risk for cardiovascular events. “[It] can cause a disruption of the body’s metabolic homeostasis [balance],” leading to diabetes and cholesterol issues, both of which raise cardiovascular disease risk, Dr. Chow says. For this reason, the medications abacavir and lopinavir/ritonavir are not recommended if you have a high risk of cardiovascular disease from lifestyle and clinical factors.
HIV and Bones
Because of its inflammatory effects, HIV affects the bones by disrupting new bone formation while also increasing the activity of proteins that drive the natural process of bone breakdown.
Certain older HIV medications, particularly tenofovir disoproxil fumarate (TDF), can further impact bone loss by causing deficiencies in vitamin D and calcium in the bones, Chow says. Ultimately, this means that people with HIV have an increased risk of getting osteopenia (reduced bone density) or osteoporosis than those without HIV, and this risk is even higher for those taking TDF.
“A lot of people are no longer using the older version of tenofovir,” Dr. Blumenthal says. “People are using tenofovir alafenamide now, which does not accumulate in the bones and does not cause that toxicity.”
Because of the impact of both HIV and certain HIV medications on the heart and bones, it’s important to be aware of which screenings you should be receiving, as well as what lifestyle modifications you can make to promote a healthy heart and bones.
Get Regular Cardiovascular Screenings
Regular cardiovascular screenings are critical for catching heart health issues early. Federal guidelines stress that you should receive a lipid (cholesterol) panel once you start HIV care, three to six months after starting ART, and then at least annually if you’re over 40 or taking a cholesterol-lowering medication.
Maintaining healthy blood glucose levels and blood pressure are also important for heart health because both diabetes and hypertension (high blood pressure) increase cardiovascular disease risk. Blood pressure monitoring is part of regular health checkups, and your provider may recommend a fasting blood glucose test every year.
Your provider will also use risk assessment tools to determine your likelihood of developing atherosclerotic cardiovascular disease (ASCVD) within 10 years, based on various factors like your cholesterol levels, BMI, and smoking status. Federal guidelines recommend annual ASCVD risk assessments with a tool called Pooled Cohort Equations for people with HIV ages 40 to 75.
Your provider may use another risk assessment tool called PREVENT, which “takes into account not just lipids, blood pressure, and smoking, but also other factors like diabetes, hemoglobin A1C, prediabetes, and kidney disease,” Chow says. But some studies suggest PREVENT equations may under-predict risks for people with HIV.
Regardless of your risk score, “we have new primary care guidelines that essentially recommend that people [with HIV] above age 40, with very few exceptions, get started on a statin to lower their cholesterol,” Blumenthal says. A large trial showed that this preventive treatment significantly reduced cardiovascular disease risk in people with HIV.
Schedule Routine Bone Density Testing (DEXA Scans)
Typically, the first sign of bone loss is a fracture or broken bone, making routine screenings for bone mineral density loss vital. Such tests are the only way to determine if you have osteoporosis or osteopenia, and the most widely used is called a DEXA (dual-energy X-ray absorptiometry) scan.
“It's recommended that we start doing bone scans at age 50 because of the association between HIV, chronic inflammation, and bone health,” Blumenthal says. You will need to do your baseline scan earlier if you are postmenopausal.
How often you need to do these scans depends on the results of your baseline scan: about every 1 to 2 years if you have low bone density and up to every 6 or more years if you have normal or mildly reduced bone density.
Make Smart Lifestyle Choices
Smart lifestyle choices can help keep your bones and heart strong. Some simple tips include:
- Quitting or avoiding smoking
- Limiting your alcohol consumption
- Maintaining a healthy weight for you
- Managing other conditions like diabetes and hypertension
Proper diet and exercise are also important, but what works for someone else may not necessarily work best for you. “It's important to look at the individual first, in terms of trying to get them to exercise and eat whole, healthy foods,” Chow says. Speak with your doctor if you need help getting started — they should be able to provide you with resources or experts who can help develop an individualized plan.
Fuel Your Body With the Right Foods
To develop healthy bones when you have HIV, you should get about 1,000 to 1,200 mg of calcium and 600 IU of vitamin D daily, which you can get from a combination of dietary supplements and foods like:
- Dairy products
- Leafy greens
- Fatty fish
- Egg yolks
- Fortified foods
A heart-healthy diet calls for lots of fruits, vegetables, and whole grains, with limited saturated fats, added sugars, and salt.
Both Blumenthal and Chow also recommend cutting back on processed foods.
Add Weight-Bearing and Aerobic Exercises
Federal guidelines recommend all adults get 150 minutes of moderate activity a week, plus muscle-strengthening exercises twice a week. This should include a mix of aerobic (cardio) and weight-bearing or resistance exercises, and there are many options to choose from.
“I try to home in on what patients really enjoy doing,” Blumenthal says. “Telling someone that they need to start running three times a week for half an hour obviously isn’t going to work for a lot of people — that wouldn’t even work for me.”
Some options for physical activity include:
- Brisk walking
- Gardening
- Biking
- Dancing
- Swimming
- Weight lifting
- Stair climbing
And remember that getting in weight-bearing exercises “doesn’t mean you have to join a gym,” Blumenthal says. “You could use cans of food or buy 5-pound weights at low cost.”
Resources We Trust
- Mayo Clinic: Strategies to Prevent Heart Disease
- Cleveland Clinic: 9 Tips for Healthy Bones
- American College of Cardiology: CVD Risk Estimator Plus
- American Heart Association: People Living With HIV Face Challenging CVD Health Risks and Barriers to Accessing Care
- The Well Project: Bone Health and HIV
Earlier versions of this article incorrectly stated you should get about 1,000 to 12,000 mg of calcium daily. It should have read 1,000 to 1,200 mg.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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- Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV: Interruption of Antiretroviral Therapy. ClinicalInfo. September 24, 2026.
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- Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV: Cardiovascular and Metabolic Complications in People With HIV. ClinicalInfo. September 25, 2025.
- Schinas G et al. Bone Disease in HIV: Need for Early Diagnosis and Prevention. Life. April 17, 2024.
- Diabetes and Heart Disease. Heart Foundation.
- Kerr C et al. Primary Care for Adults With HIV. New York Department of Health AIDS Institute. November 11, 2025.
- Durstenfeld MS. Prediction of Cardiovascular Risk Among People with HIV Using the PREVENT Equations Compared to the Pooled Cohort Equations. Journal of General Internal Medicine. June 6, 2025.
- New Guidelines for Use of Statins by People with HIV to Prevent Cardiovascular Events. HIV.gov. February 29, 2024.
- Bone Health and HIV. The Well Project. August 25, 2026.
- HIV and Heart Health: What You Need to Know. HIV.gov. January 28, 2026.
- Vitamin D and Calcium. Johns Hopkins Medicine.
- HIV and Opportunistic Infections, Coinfections, and Conditions: HIV and Heart Disease. HIV.gov. March 31, 2025.
- Physical Activity Guidelines for Americans. Office of Disease Prevention and Health Promotion. June 23, 2023.
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