Coronary artery disease occurring with protease inhibitor therapy

Sullivan, A K; Nelson, Matthew R.; Moyle, Graeme; Newell, Alexa; Fehér, M; Gazzard, B. G.

doi:10.1258/0956462981921251

Cited by 32 publications

(8 citation statements)

References 2 publications

(2 reference statements)

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“…In most cases of cardiovascular complications reported in patients receiving a PI-containing regimen, at least 1 known risk factor could be identified [1,2,9,10]. Smoking is a common behavior among HIV-1-infected subjects [11].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Coronary Heart Disease in Patients Treated for Human Immunodeficiency Virus Infection Compared with the General Population

Savès

Chêne

Ducimetière

et al. 2003

Clinical Infectious Diseases

365

220

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The distribution of risk factors for cardiovascular disease in patients aged 35-44 years who were treated for human immunodeficiency virus type 1 (HIV-1) infection was compared with that for a population-based cohort. HIV-1-infected men treated with a protease inhibitor-containing regimen (n=223), compared with HIV-1-uninfected men (n=527), were characterized by a lower prevalence of hypertension, a lower mean high-density lipoprotein cholesterol level, a higher prevalence of smoking, a higher mean waist-to-hip ratio, and a higher mean triglyceride level. No difference was found for total plasma or low-density cholesterol levels, nor for the prevalence of diabetes. Similar trends were observed among female subjects. The predicted risk of coronary heart disease was greater among HIV-1-infected men (relative risk [RR], 1.20) and women (RR, 1.59; P<10(-6) for both), compared with the HIV-1-uninfected cohort. The estimated attributable risks due to smoking were 65% and 29% for HIV-1-infected men and women, respectively. Because most HIV-1-infected people will ultimately need antiretroviral therapy, risk factors for cardiovascular disease should be determined at the initiation of treatment, and interventions should be considered for all patients who have them.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Coronary Heart Disease in Patients Treated for Human Immunodeficiency Virus Infection Compared with the General Population

Savès

Chêne

Ducimetière

et al. 2003

Clinical Infectious Diseases

365

220

View full text Add to dashboard Cite

show abstract

“…The description of these multiple lipid abnormalities has raised concern about the atherogenic potential of these changes and the subsequent development of serious cardiovascular and cerebrovascular morbidity and mortality. Reports of myocardial infarctions in patients on antiretroviral therapy including PIs heighten this concern [40–42]. Recent studies have also described an increased incidence of surrogates of atherosclerotic disease, including intimal thickening and calcification of the carotid arteries [43,44] and coronary artery calcification [45].…”

Section: Discussionmentioning

confidence: 99%

Antiretroviral therapy in HIV‐positive men is associated with increased apolipoprotein CIII in triglyceride‐rich lipoproteins

et al. 2005

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Dyslipidaemia has become a common problem in HIV disease, especially in patients on current antiretroviral therapy. However, the pathogenic mechanisms involved are not well understood or documented using conventional lipid measurements. MethodsUsing a cross-sectional design, the prevalence of abnormal standard lipid measurements and novel biomarkers for abnormal lipid metabolism was determined in 271 HIV-positive men from two HIV clinics in Atlanta, GA, USA. ResultsA total of 147 men were treated with protease inhibitors (PIs) for 43 months (54%), 84 were treated with nonnucleoside reverse transcriptase inhibitors (NNRTIs) for 43 months (31%) and 40 had not received antiretroviral therapy in the past 3 months (15%). Patients being treated with a PI had higher total cholesterol and triglyceride (TG) levels than patients on no therapy (Po0.05 for each). Patients in the NNRTI group had higher TG, lower high-density lipoprotein (HDL) levels, and higher low-density lipoprotein (LDL) levels than patients on no therapy (Po0.05 for each). Patients treated with either PIs or NNRTIs were more likely to have higher apolipoprotein CIII (apoCIII) levels (Po0.05 for each) than patients on no therapy. Elevated TG was associated with disproportionably elevated apoCIII levels in both treatment groups. ConclusionsIn this cross-sectional study of HIV-infected men, either PI or NNRTI therapy elevated levels of TG and apoCIII. Higher concentrations of apoCIII in apoB-containing lipoproteins [very low-density lipoproteins (VLDLs), intermediate density lipoprotein (IDL) and LDLs] have been predictive of an increased incidence of coronary events in clinical trials and more rapid progression of coronary lesions measured by angiography. These findings, on a background of an older population with additional risk factors of smoking and diabetes, portend future atherosclerotic events in these patients.

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“…2003;163:457-460 R EPORTED SERIES of patients have suggested that patients infected with human immunodeficiency virus (HIV) are at an increased risk of premature coronary artery disease (CAD), linked predominantly to the hyperlipidemia and insulin resistance that are associated with protease-inhibitor therapy. [1][2][3][4][5][6][7][8][9] However, necropsy studies had demonstrated premature CAD in HIV-infected patients even before the advent of protease inhibitors. 10,11 Few data exist regarding the course of acute coronary events in HIVinfected patients.…”

Section: Discussionmentioning

confidence: 99%