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Calming Concerns About Antiretroviral Therapy

Some good news about short-term vascular risk from antiretroviral drugs

HIV infection is associated with lipid and insulin disorders. Small studies have suggested that HIV infection and antiretroviral drug therapy might be associated with premature cardiovascular and cerebrovascular disease. These investigators developed an anonymous, retrospective database of 36,766 patients (98% male; 52% black) who used Veterans Affairs services for HIV disease from January 1993 through June 2001. Seventy percent of the cohort took antiretroviral drugs for a mean of 15 months. Mean follow-up was 40 months.

Rates of hospital admissions for cardiovascular or cerebrovascular events remained roughly steady from 1993 to 1995, when highly active antiretroviral therapy was introduced. From 1995 forward, these rates actually declined overall. Multivariable analysis showed no association between antiretroviral therapy and risk for cardiovascular or cerebrovascular admissions, regardless of which antiretroviral-drug class, or combination of classes, was used. In an analysis that adjusted rates of cardiovascular and cerebrovascular admissions in the U.S. population to match the age and sex distribution of the study cohort, the cohort actually had lower rates than those of the U.S. population.

Comment: These retrospective data from VA patients do not support the contention that antiretroviral therapy increases risk for vascular disease. However, adverse vascular effects may not have had time to emerge in the mean 15 months of treatment in this cohort, and cardiovascular risk-factor data were lacking. Nevertheless, these short-term results are reassuring in their suggestion that substantial antiretroviral-associated cardiovascular and cerebrovascular risks may not even exist.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology April 4, 2003

Citation(s):

Bozzette SA et al. Cardiovascular and cerebrovascular events in patients treated for human immunodeficiency virus infection. N Engl J Med 2003 Feb 20; 348:702-10.

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• Medline abstract (Free)

Kuritzkes DR and Currier J. Cardiovascular risk factors and antiretroviral therapy. N Engl J Med 2003 Feb 20; 348:679-80.

• Original article (Subscription may be required)
• Medline abstract (Free)