MI risk increases with duration of HIV protease inhibitor treatment

NEW YORK (Reuters Health) - In men infected with HIV, the risk of MI appears to increase with duration of treatment with a protease inhibitor (PI), according to analyses of the French Hospital Database on HIV.

Thus, investigators suggest in the November 21st issue of AIDS that clinicians may want to consider patients’ cardiovascular disease risk factors in PI treatment decisions.

Dr. Murielle Mary-Krause, at INSERM EMI-214 in Paris, and her team looked at data collected prospectively for nearly 35,000 men with HIV infection. Sixty subjects had an MI between 1996 and 1999, including 49 that occurred in subjects exposed to PI.

Estimated incidence was 8.2 per 10,000 person-years in patients exposed to PI for < 18 months, increasing to 15.9 and 33.8 per 10,000 person-years among those exposed for 18 to 29 months and for 30 months or more, respectively.

In contrast, the expected incidence of MI in the general male population of similar ages was 10.8 per 10,000 person-years. Dr. Mary-Krause and colleagues point out that exposure to PI for at least 30 months tripled that risk.

They caution that the increased life expectancy associated with highly active antiretroviral therapy outweighs the associated risk of MI. Nonetheless, they advise that treatment decisions take into account risk factors for heart disease, which should be determined prior to and throughout treatment. Lipid-lowering agents should be chosen based on lack of interaction with antiretroviral drugs.

"It seems prudent to at least consider individually managing patients with respect to their risk of developing coronary artery disease," Dr. Peter Reiss, of the University of Amsterdam, suggests in an accompanying editorial. Physicians should encourage smoking cessation and appropriate dietary and exercise modifications, while using lipid-lowering and antihyperglycemic agents judiciously.

AIDS 2003;17:2479-2486,2529-2531.