Smoking cessation was the only factor associated with a reduction in a major indicator of an increased risk of cardiovascular disease in a French cohort of HIV-positive patients, according to a study published in the April 29th edition of AIDS.
Investigators from the Aquitaine Cohort study examined the impact of strategies including HIV treatment change, the use of lipid-lowering drugs and smoking cessation on intima-media thickness (a marker for atherosclerosis, or hardening of the arteries, an early indicator of cardiovascular disease risk) and found that “the potential impact of smoking cessation…should encourage its active promotion by clinicians providing HIV care.”
Earlier studies have shown increased IMT thickness amongst HIV-positive patients taking HAART. Traditional risk factors for cardiovascular disease including older age, male sex, smoking, total cholesterol and increased body mass index (BMI) have been shown by previous studies to be associated with IMT thickness in HAART-treated individuals.
Interventions to reduce the risk of cardiovascular disease in patients taking anti-HIV therapy are therefore recommended. Investigators from the Aquitaine Cohort analysed data from the SUPRA study, involving patients from five treatment centres in southern France to assess the impact of various interventions on IMT over a three-year period. Recruitment occurred between autumn 1999 and spring 2000 but follow-up was not provided until 2004.
IMT and lipids were measured at baseline and then again after 12 and 36 months. Data were collected on the cardiovascular risk reduction strategies employed, including alterations to HIV treatment regimen, the use of lipid lowering drugs and smoking cessation.
A total of 233 individuals were included in the investigators analysis. The median age at baseline was 44 years, 57 (25%) were women, 138 (59%) were current smokers and 74 (32%) had been diagnosed with AIDS.
On entry to the study, 200 individuals (86%) were taking HAART, of which 127 were taking a regimen including a protease inhibitor. Five patients were taking fibrates at baseline and none were taking statins. During the next twelve months, eight new patients started taking fibrates, eight commenced therapy with statins, 42 altered their anti-HIV treatment regimen and stopped taking a protease inhibitor and ten individuals stopped smoking.
At the initial twelve month period of evaluation, these interventions had no impact on lipid levels, but median IMT levels increased significantly from 0.55mm to 0.57mm (p
During the next 24 month period of analysis, a further 52 patients switched to a non-protease inhibitor HAART regimen, 30 additional individuals started taking lipid lowering drugs and 14 more patients stopped smoking. This meant that at the end of the 36 month period of analysis 40 patients (17%) were taking fibrates or statins, 141 (60%) were taking an anti-HIV treatment regimen that did not include a protease inhibitor, and 114 (49%) were non-smokers.
In the second 24 month period lipids fell significantly (p
When the investigators looked at the impact of interventions to lower cardiovascular risk and IMT at an individual level, they found that the only significant association was with smoking cessation (p = 0.06).
The investigators conclude, “the potential impact of smoking cessation…should encourage its active promotion by clinicians providing HIV care.”
Thiebaut R et al. Change in atherosclerosis progress in HIV infected patients: ANRS Aquitaine Cohort, 1999 – 2005. AIDS: 19 (7): 729 – 731, 2005.