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Title: Antiretroviral Treatment Lowers Cardiovascular Risk in HIV+ Patients
URL: http://www.pslgroup.com/dg/2278C2.htm
Doctor's Guide
August 8, 2008

NEW YORK -- August 8, 2008 -- Antiretroviral medications for human immunodeficiency virus (HIV) do not seem to increase the risk of cardiovascular events, according to a pair of studies in the August issue of AIDS.

The 2 studies, using surrogate markers linked to a high risk of later cardiovascular disease, lend new insights into how anti-HIV therapies affect risk. Together, the reports suggest that antiretroviral medications and the resulting improvements in immune function are linked to reductions, not increases, in cardiovascular risk.

The first study evaluated the association of HIV infection and cumulative exposure to highly active antiretroviral therapy (HAART) with the presence and extent of coronary artery calcification (CAC).

Lawrence A. Kingsley, PhD, University of Pittsburgh, Pittsburgh, Pennsylvania, and colleagues used a specialised computed tomography (CT) scan to measure CAC levels in approximately 947 HIV+ (n = 615) and HIV- men (n = 332). Of the HIV+ patients, 531 were HAART-experienced.

For HIV+ and HIV- men alike, the factor most strongly related to the presence of CAC was older age. After adjustment for age, race, family history, smoking, high-density lipoprotein-C, low-density lipoprotein-C, and hypertension, HIV infection (odds ratio [OR] = 1.35; 95% confidence interval [CI], 0.70-2.61) and long-term HAART use (OR = 1.33; 95% CI, 0.87-2.05) increased the odds for presence of CAC.

However, after adjustment for all of these risk factors, the extent of CAC was lower among HAART users. Among those not taking lipid-lowering therapy, HAART usage of at least 8 years was associated with significantly reduced CAC scores (relative CAC score, 0.43; 95% CI, 0.24-0.79).

The second study, led by Robert Kaplan, MD, Albert Einstein College of Medicine, Bronx, New York, used ultrasound techniques to measure indicators of atherosclerosis in the carotid arteries supplying the brain.

The study included patients in the Women's Interagency HIV Study (1331 HIV+, 534 HIV-) and the Multicenter AIDS Cohort Study (600 HIV+ men, 325 HIV- men).

The results showed that a low CD4+ cell count was associated with an increased prevalence of carotid lesions. For HIV+ patients with a CD4+ cell count of <200 cells/mL, the risk of carotid atherosclerosis was 100% higher for women and 74% higher for men.


SOURCE: Wolters Kluwer Health

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