Cardiovascular risks associated with protease inhibitors for the treatment of HIV

Area of Science:

• HIV treatment
• Cardiovascular disease
• Pharmacology

Background:

• First-generation protease inhibitors are linked to dyslipidemia and cardiovascular disease (CVD).
• Contemporary protease inhibitors, atazanavir and darunavir, exhibit improved lipid profiles and tolerability.
• These newer agents remain relevant in various HIV treatment regimens.

Purpose of the Study:

• To review evidence on the association between atazanavir and darunavir and ischemic CVD risk.
• To assess the impact of these protease inhibitors on atherosclerotic markers.
• To evaluate their role in drug discontinuation and mortality.

Main Methods:

• Searched PubMed for randomized trials and observational studies from 2000 onwards.
• Included search terms: protease inhibitors, darunavir, atazanavir, cardiovascular disease, dyslipidemia, mortality, and atherosclerotic markers.
• Also searched clinicaltrials.gov and HIV conference abstracts (2015-2020).

Main Results:

• Atazanavir and darunavir are associated with fewer detrimental lipid effects than older protease inhibitors.
• Evidence suggests a potentially lower risk of ischemic CVD events and progression of atherosclerosis.
• Further research is needed to fully elucidate long-term cardiovascular outcomes.

Conclusions:

• Atazanavir and darunavir represent safer options regarding lipid profiles and cardiovascular risk in HIV treatment.
• Consideration of baseline cardiovascular risk is essential when initiating these drugs.
• These protease inhibitors will likely continue to be used globally in HIV management.