HIV-positive men in early middle age using protease inhibitors as part of a HAART regimen appear to be at no greater short-term risk of heart attack or developing heart disease than similarly aged HIV-positive men who are treated with other antiretrovirals, according to an ongoing US study published in 15 August 2002 edition of the Journal of Acquired Immune Deficiency Syndromes. However, the study also found men with HIV regardless of whether or not they are treated with a protease inhibitor - are at a greater risk of heart attack and heart disease than HIV-negative men.
Investigators at the Kaiser Permanente Medical Center in North California have been conducting a retrospective analysis of the clinical records of HIV-positive male patients dating back five and a half years to the first widespread use of protease inhibitors in HAART combinations, to see if taking these drugs could be linked to heart attack or heart disease.
The charts of 4,159 HIV-positive men aged 35-64, the highest risk age group for heart disease, have been included in the study. A total of 6,793 patient years of non-protease inhibitor exposure time have been considered and a little over 8,000 years patient years of protease inhibitor exposure.
In addition, the records of 2,550 HIV-positive male patients from the same age group contributed a little over 3,900 patient years of non-HAART treatment for control purposes. The study was further controlled by analysing the medical records of a random selection of 39,877 male HIV-negative men from the same age group.
A total of 72 hospitalisations for heart problems, including 47 heart attacks were recorded in the HIV-positive group. There was no statistically significant difference in the likelihood of men receiving protease inhibitors experiencing coronary heart disease compared to HIV-positive men treated with other antiretrovirals.
However episodes of heart disease and heart attack were 50% more likely to occur in HIV-positive men than HIV-negative men, even when controlled for risk factors such as smoking, hyperlipidemia, high blood-pressure and diabetes.
The investigators note that their findings are consistent with the conclusions of a large study conducted between January 1997 and June 2001 involving over 36,000 HIV-positive patients attending US Veterans Affairs hospitals, which found that increased protease inhibitor use could not be associated with a rise in hospital admissions or deaths involving heart problems.
Regarding the increased rates of heart problems which the Kaiser study found in HIV-positive men compared to their HIV-negative peers, the investigators note that it has been suggested that HIV, as well as other chronic infections such as cytomegalovirus or chlamydia my increase the likelihood of coronary heart disease, adding that these mechanisms need to be studied further.
Klein D etal. Do protease inhibitors increase the risk of coronary heart disease in patients with HIV-1 infection? Journal of Acquired Immune Deficiency Syndromes 30: 471-477, 2002.