Five Antiretroviral Combinations Associated With Increased Risk Of A Cardiovascular Event

By Michael Carter

 

Treatment with four individual and five combinations of anti-HIV drugs is associated with an increased risk of a cardiovascular event, investigators from the United States report in the online edition of Clinical Infectious Diseases.

But the authors emphasize that the absolute risk of an event was low and suggest “the primary consideration in choice of ART [antiretroviral therapy] regimen should be its efficacy for HIV and tolerability. In situations in which equally effective regimens are available, clinicians may want to consider the potential elevation in risk of cardiovascular events, particularly in patients who are older or who have cardiovascular risk factors.”

The life expectancy of many people with HIV is now normal. However, cardiovascular disease is an important cause of serious illness and death in people with HIV. The reasons for this are not yet fully understood. Traditional risk factors are thought to have an important role, so too the inflammatory effects of HIV infection. But individual anti-HIV drugs, especially abacavir and protease inhibitors, have been associated with an increased risk of a cardiovascular event in some studies.

HIV therapy consists of treatment with a combination of at least three antiretroviral drugs. It is therefore important to know if specific drug combinations can increase the risk of cardiovascular events.

To answer this question, investigators designed a study involving 24,510 people with HIV enrolled in the Veterans Health Administration Case Registry, who received antiretroviral therapy between 1996 and 2009.

“We chose to evaluate combinations of ART drugs because the drugs are always used in combination,” explain the authors. “It is possible that combinations of drugs may elevate cardiovascular risk in a way that would not be discoverable by assessing only individual drugs, or by assessing classes of drugs, as prior studies have done.”

Fifteen individual drugs and 23 combinations were considered in the investigators’ analyses. Integrase inhibitors and newer non-nucleoside reverse transcriptase inhibitors (NNRTIs) were not included, but older drugs such as indinavir, nelfinavir and full-dose ritonavir were included.

The study participants had an average baseline age of 47 years. Almost half (47%) had a history of smoking and 12% had evidence of diabetes. Although fewer than 1% of individuals had experienced a cardiovascular event at baseline, some 18% had been taking statins for a year or more. The authors believe that the high prevalence of cardiovascular risk factors made this an especially appropriate population in which to examine the association between individual antiretroviral drugs and combinations and the risk of cardiovascular events – heart attack, stroke, percutaneous coronary intervention (angioplasty) and bypass surgery.

During over 164,000 years of follow-up, 934 people experienced a cardiovascular event.

The study looked at the relationship between current exposure to drug combinations at the time of an event rather than cumulative exposure.

Read the full article here: AIDSMAP