Infection with HIV increases the risk of coronary heart disease in younger, but not older HIV-positive patients, according to a large US study published in the August 1st edition of the Journal of Acquired Immune Deficiency Syndromes.
Investigators in California conducted a review of the medical records of every patient who used the State’s Medi-Cal programme between 1994 and 2000 with the aim of comparing the incidence of coronary heart disease across seven age groups among HIV-positive and HIV-negative Californians. Investigators also wished to establish the impact of treatment with antiretroviral drugs on the frequency of heart disease in the HIV-positive patients.
Over 70,000 person years of follow-up were provided by the HIV-positive patients, and over 8,000,000 person years by the HIV-negative Medi-Cal users. A total of 1,360 cases of coronary heart disease were detected in HIV-positive individuals and 234,541 in HIV-uninfected people.
Compared with their HIV-negative peers, the incidence of coronary heart disease was significantly higher in HIV-positive men aged between 18-25 (RR 6.76, 95% CI, 3.36 – 13.58), and 25 – 34 years (RR 2.16, 95% CI, 1.81 – 2.58).
In addition, younger HIV-positive women were also found to have a significantly increased risk of heart disease, with a risk ratio of 2.47 (95% CI, 1.23 – 4.95) for women aged 18 – 24, 1.53 (95% CI, 1.10 – 2.13) for women aged between 25 – and 34 years, and 1.67 (95% CI, 1.41 – 1.97) for 35 – 44 year old HIV-positive women.
However, HIV-positive men and women aged over 45 did not have an increased risk of coronary heart disease. Nevertheless, the increased risk of heart disease seen in younger patients “is comparable in magnitude with the increase associated with aging.” in HIV-negative individuals.
Investigators also looked for evidence of a link between treatment with antiretroviral drugs and heart disease in HIV-positive individuals, and established that 18 – 33 year olds treated with anti-HIV drugs had a risk ratio of developing heart disease of 2.06 (95% CI, 1.42 – 2.99, p
The investigators conclude that HIV infection is a risk factor for cardiovascular disease and that as well as paying attention to traditional risk-factors for heart disease, doctors should use HAART regimens which do not “adversely impact a patient’s cardiovascular risk.”
Further information on this website
The heart - factsheet
HAART patients have increased risk of heart disease say French - news story July 2003
Currier JS et al. Coronary heart disease in HIV-infected individuals. JAIDS 33: 506 – 512, 2003.