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HIV Therapy's Impact on Heart Disease Small but Bears Watching
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By Ed Susman, MedPage Today Staff Writer
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco
August 14, 2006
www.medpagetoday.com
TORONTO, Aug. 14 -- The risk of cardiovascular disease is elevated in patients who are being treated with potent antiretrovirals to control HIV infection.
However, the risk of heart disease pales beside the benefit of the antiretroviral combination therapies that turned HIV infection into a chronic disease, albeit incurable.
"The antiretroviral drug regimens have reduced by 90% the risk of death and have sustained that reduction for at least 10 years," said Jens Lundgren, M.D., director of the Copenhagen HIV Program and a professor of infectious disease epidemiology at the University of Copenhagen in Denmark.
He spoke at a mini-satellite symposium, Metabolic Complications: New Insights and Evolving Management Strategies, sponsored by Bristol-Myers Squibb Canada in conjunction with the 16th International AIDS Conference. "At the moment, what is dominating our clinical management is control of the virus, but that might not be the case in five to 10 years from now," Dr. Lundgren said."
He reviewed various clinical trials that show that HIV management tools -- particularly protease inhibitors -- are associated with increased risks of cardiovascular disease. "We have seen that the risk of heart disease increases 16% a year if a patient is on protease-inhibitor based highly active antiretroviral therapy," Dr. Lundgren said.
At that rate the risk of heart disease doubles every four to five years. He said that HIV patients being treated with a non-nucleoside reverse transcriptase-based antiretroviral therapy do not appear to show the same increased risks as do patients on the protease treatments.
"It remains unknown whether individual drugs within each of these drug classes affect risks differently," he said.
However, Dr. Lundgren said that in a population of HIV patients who are in their 30s and 40s that risk is quite low to start. After eight to 10 years on HIV therapy, the risk increases from about 2% around 8% and by then these patients are in their 40s and 50s.
Dr. Lundgren also noted that the increased risk because of the use of anti-HIV drugs is far from the only risk factor these patients face. In fact, he said. The patients also face risk from increasing age, a family history of heart disease, high levels of lipids and smoking.
"Low density lipoprotein cholesterol is as harmful to a person with HIV as it is to a person in the general population," Dr. Lundgren said.
"These data should remind us," said symposium co-chairman Julian Falutz, director of the HIV Metabolic Clinic at McGill University in Montreal, "that we need to take time to talk to our patients about smoking cessation."
He said getting patients to stop smoking can reduce the risk of cardiovascular disease by 50%.
In fact, Dr. Lundgren made a similar point, showing studies that showed a halving of the risk of heart attacks within five years after people stop cigarette smoking.
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