Researchers, whose report appeared in JAMA Internal Medicine, aren't sure what explains the higher heart attack rate in HIV-positive people, but they speculate it's a combination of the effects of HIV itself and the antiretroviral drugs used to treat it.
"It's a complicated picture," said Matthew Freiberg, who led the study at the University of Pittsburgh School of Medicine in Pennsylvania. "We're still trying to understand the mechanisms."
Just over 1.1 million people in the U.S.
Because treatment now allows HIV-infected people to live longer, researchers have started turning their attention to the other health problems those people face later in life, such as heart disease.
The study included more than 82,000 U.S. veterans, almost all men. About one-third of them were infected with HIV.
During an average of almost six years, 871 of the study participants had a heart attack, of which 176 were fatal. Veterans with HIV were consistently more likely to suffer a heart attack than HIV-negative veterans, whether in their 40s, 50s and 60s.
After Freiberg and his colleagues took into account participants' other heart risks, including high blood pressure, diabetes and drug and alcohol use, those with HIVwere still 48 percent more likely to have a heart attack.
The findings suggest antiretroviral drugs accounted for at least part of the extra risk among people with HIV, but past studies have shown that the virus itself also contributes to heart problems, Freiberg said.
"It may be that HIV as it's in your body, like other infections, may be promoting an inflammatory response that is leading to these increased risks of heart attack," he told Reuters Health - but so far, that's just a theory.
Past research has shown a link between HIV and cardiovascular disease, said Patrick Mallon, from the University College Dublin School of Medicine and Medical Science.
But it's been unclear whether other differences between groups of people with and without HIV -- such as smoking rates and cholesterol levels, for example -- could be driving the extra risk. The new report clears that up by looking at two very similar groups of people where HIV status is one of the only differences, Mallon said.
"There have been a lot of signals for a very long time in HIV, and we're now starting to see people constructing studies properly that really give us some very clear answers," he said. HIV has also been linked to disturbances in fat use and storage in the body.
Mallon and Freiberg agree that people with HIV should make sure they do what they can to cut heart disease.
"There's a lot that the individual can do to mitigate their risk along the lines of lifestyle interventions," Mallon said. "At a personal level, that would be step number one."