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ATV vs NFV: heart disease risk
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Do Different Protease Inhibitors Used for Human Immunodeficiency Virus Have Varying Effects on Coronary Heart Disease Risk?
Reported by Jules Levin
E. L. GILLESPIE, C. M. WHITE, C. I. COLEMAN;
Univ. of CT/Hartford Hosp., Storrs, CT.
Hyperlipidemia increases a patient's risk for coronary heart disease (CHD). Human immunodeficency virus (HIV) patients who develop lipid abnormalities as a result of their highly active anti-retroviral therapy (HAART) may face the same elevation in cardiovascular risk. This study compares the 10-year CHD risk of HIV patients receiving the protease inhibitors (PIs) atazanavir and nelfinavir.
Data from a randomized, controlled study evaluating efficacy and safety of atazanavir 400 mg daily (n=101) and nelfinavir 750 mg three times daily (n=100) (as part of HAART including didanosine and stavudine in treatment naive patients) was incorporated into two 5,000 patient Monte Carlo simulations. Probability distributions of baseline low-density lipoprotein (LDL) and high-density lipoprotein (HDL) values and percentage change in LDL and HDL at 48-weeks following PI administration were developed to estimate on-treatment lipid profiles. These distributions of LDL and HDL values were then used to model patients' 10-year CHD risk using the Framingham risk equation for men in the presence or absence of additional CHD risk factors.
Results
Patients receiving atazanavir had a lower 10-year risk of CHD compared to patients receiving nelfinavir (p<0.001). This lower incidence of CHD with atazanavir was preserved for patients despite smoking status, diagnosis of diabetes mellitus and hypertension (p<0.001 for all comparisons).
Conclusion: Based on our model, selecting a PI, such as atazanavir, which is less likely to be associated with dyslipidemias may reduce patients' risk for developing CHD.
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