HIV-positive individuals taking a HAART combination including a protease inhibitor (PI )have a slight, but significant, increased risk of long-term coronary heart disease compared to the general population, according to a French study published in the online edition of Clinical Infectious Diseases.
The investigators compared 247 HIV-positive men and women, aged between 35 and 44 who started a PI containing HAART regimen, with a sample of 1038 age and sex matched HIV-negative people.
Risk factors for coronary heart disease were assessed and the investigators calculated five year risk ratios of heart disease in the HIV-positive patients versus the general population.
At baseline, the HIV-positive patients had an average CD4 cell count of 451 cells/mm3 and a viral load of 200. Average duration of antiviral therapy was 26 months, and the patients had been taking a PI containing regimen for an average of 13 months.
Men made up the majority of both study samples (81% of HIV-positive patients, 51% of the general sample). HIV-positive men had significantly more risk factors for coronary heart disease than men in the general population. These included a higher prevalence of smoking (56.6% versus 32.2%), higher triglycerides (32.3% triglycerides above 2.2mmol/L versus 13.5%) and lower HDL cholesterol (44.9% below 1.0mmol/L versus 23.1%). However, total cholesterol, LDL cholesterol and the prevalence of diabetes did not differ between the HIV-positive and HIV-negative male samples. HIV-positive women had significantly higher total cholesterol than that seen in the general population (51.1% above 5.5mmol/L versus 44.4%).
Investigators calculated that the five year risk ratio for coronary heart disease in HIV-positive patients versus the general population was 1.20 for men and 1.59 for women (p-6). Smoking accounted for 65% of this risk in HIV-positive men and 29% in HIV-positive women.
The investigators note that, compared to the general population, HIV-positive patients receiving a PI “are thin; they have elevated triglyceride levels and low HDL cholesterol…and they are frequent smokers. This yields a moderately, albeit significantly higher predicted risk [for coronary heart disease] in HIV-infected, PI-treated patients, compared with the general population, and smoking strongly contributed to this risk.”
Patients in the study had only been receiving HAART for a short period of time, note the investigators, who anticipate a higher risk of coronary heart disease the longer the duration of therapy. The investigators emphasise that this has already been noted in the French hospital database and the DAD study.
The investigators say that it is not possible to say to what extent the inflammatory effects of chronic HIV infection, treatment with HAART, or an interaction between the two, contributed to the increased risk of heart disease they observed in HIV-positive patients. However, they did find that smoking was a clear and independent risk factor for heart disease and recommend that all patients have their risk of cardiovascular disease assessed before starting HAART.
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Saves M et al. Risk factors for coronary heart disease in patients treated with human immunodeficiency virus infection compared to the general population. Clinical Infectious Diseases 37 (on-line edition), 2003.