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Rapid Screening of HIV Reverse Transcriptase and Integrase Inhibitors
Published on: April 10, 2014
Cardiovascular and cerebrovascular events in patients treated for human immunodeficiency virus infection
Samuel A Bozzette1, Christopher F Ake, Henry K Tam
1Veterans Affairs Quality Enhancement Research Initiative for HIV and the Center for Research in Patient Oriented Care at the Veterans Affairs San Diego Health Care System, San Diego, Calif 92161, USA. sbozzette@ucsd.edu
Insights
Newer HIV therapies significantly reduce mortality without increasing cardiovascular or cerebrovascular events. This suggests that concerns about accelerated vascular disease should not prevent the use of effective antiretroviral treatment in HIV patients.
Area of Science:
- Infectious Diseases
- Cardiology
- Public Health
Background:
- Metabolic abnormalities like dysglycemia and hyperlipidemia are common in HIV infection.
- There is concern that these metabolic issues may accelerate cardiovascular and cerebrovascular disease.
Purpose of the Study:
- To investigate the risk of cardiovascular and cerebrovascular disease in patients receiving HIV care.
- To evaluate the association between antiretroviral therapy and vascular events or mortality.
Main Methods:
- Retrospective study of 36,766 patients with HIV infection from January 1993 to June 2001.
- Analysis of antiretroviral therapy use, including nucleoside analogues, protease inhibitors, and nonnucleoside reverse-transcriptase inhibitors.
- Examination of cardiovascular, cerebrovascular, and all-cause mortality rates.
Main Results:
- Antiretroviral therapy use was associated with a decreased hazard of death from any cause.
- No relation was found between specific antiretroviral drug classes and the hazard of cardiovascular or cerebrovascular events.
- Rates of cardiovascular/cerebrovascular disease admissions and all-cause mortality decreased significantly between 1995 and 2001.
Conclusions:
- Newer HIV therapies offer substantial mortality benefits without increasing vascular event rates.
- Concerns about accelerated vascular disease should not impede short-term antiretroviral therapy decisions.
- Longer-term monitoring is necessary due to increased survival in HIV-infected individuals.
Background:
Metabolic abnormalities associated with human immunodeficiency virus (HIV) infection, including dysglycemia and hyperlipidemia, are increasingly prevalent, and there is concern about the possibility of an association with accelerated cardiovascular and cerebrovascular disease.
Methods:
We conducted a retrospective study of the risk of cardiovascular and cerebrovascular disease among the 36,766 patients who received care for HIV infection at Veterans Affairs facilities between January 1993 and June 2001.
Results:
For antiretroviral therapy, 70.2 percent of the patients received nucleoside analogues, 41.6 percent received protease inhibitors, and 25.6 percent received nonnucleoside reverse-transcriptase inhibitors for a median of 17 months, 16 months, and 9 months, respectively. Approximately 1000 patients received combination therapy with a protease inhibitor for at least 48 months, and approximately 1000 patients received combination therapy with a nonnucleoside reverse-transcriptase inhibitor for at least 24 months. Between 1995 and 2001, the rate of admissions for cardiovascular or cerebrovascular disease decreased from 1.7 to 0.9 per 100 patient-years, and the rate of death from any cause decreased from 21.3 to 5.0 deaths per 100 patient-years. Patient-level regression analyses indicated that there was no relation between the use of nucleoside analogues, protease inhibitors, or nonnucleoside reverse-transcriptase inhibitors and the hazard of cardiovascular or cerebrovascular events, but the use of antiretroviral drugs was associated with a decreased hazard of death from any cause.
Conclusions:
Use of newer therapies for HIV was associated with a large benefit in terms of mortality that was not diminished by any increase in the rate of cardiovascular or cerebrovascular events or related mortality. Fear of accelerated vascular disease need not compromise antiretroviral therapy over the short term. However, prolonged survival among HIV infected patients means that longer-term observation and analysis are required.
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