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Protease inhibitors and cardiovascular outcomes in patients with HIV-1
Scott D Holmberg1, Anne C Moorman, John M Williamson
1Division of HIV/AIDS Prevention, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA. sdh1@cdc.gov
Insights
Protease inhibitors used for HIV-1 treatment may increase the risk of heart attacks. This study found a higher frequency of myocardial infarctions in patients using these drugs.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Protease inhibitors (PIs) are crucial for treating Human Immunodeficiency Virus type 1 (HIV-1).
- Prior research suggests a link between PIs and metabolic disturbances like hyperlipidemia and hyperglycemia.
- The potential cardiovascular risks associated with PI therapy require further investigation.
Purpose of the Study:
- To investigate the association between protease inhibitor use and the risk of myocardial infarction (MI) in patients with HIV-1.
- To quantify the risk of MI in HIV-1 patients receiving PI treatment.
Main Methods:
- A cohort study of 5672 HIV-1 outpatients from nine US clinics (1993-2002).
- Comparison of MI incidence between patients taking PIs and those not taking PIs.
- Statistical analysis using odds ratio and Cox proportional hazards model, adjusted for relevant covariates.
Main Results:
- The frequency of myocardial infarctions increased after the introduction of PIs in 1996 (p=0.0125).
- Patients taking PIs had a significantly higher risk of MI (odds ratio 7.1, 95% CI 1.6-44.3).
- Adjusted analysis indicated a trend towards increased MI risk with PI use (hazard ratio 6.5, 0.9-47.8).
Conclusions:
- The use of protease inhibitors in HIV-1 treatment is associated with an increased risk of myocardial infarction.
- Although infrequent, this cardiovascular risk warrants consideration in the management of HIV-1 patients on PIs.
- Further research may be needed to elucidate the mechanisms and confirm these findings.
Abstract:
Protease inhibitors for treatment of HIV-1 have been linked with increased risk of hyperlipidaemia and hyperglycaemia. In a cohort of 5672 outpatients with HIV-1 seen at nine US HIV clinics between January, 1993, and January, 2002, the frequency of myocardial infarctions increased after the introduction of protease inhibitors in 1996 (test for trend, p=0.0125). We noted that 19 of 3247 patients taking, but only two of 2425 who did not take, protease inhibitors had a myocardial infarction (odds ratio 7.1, 95% CI 1.6-44.3; Cox proportional hazards model-adjusted for smoking, sex, age, diabetes, hyperlipidaemia, and hypertension-hazard ratio 6.5, 0.9-47.8). Our findings suggest that, although infrequent, use of protease inhibitors is associated with increased risk of myocardial infarction in patients with HIV-1.
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