Increasing morbidity from myocardial infarction during HIV protease inhibitor treatment?

Progressive Stroke in an HIV-1-Positive Patient under Protease Inhibitors

“…Although cases of isolated cerebral HIV-1-associated vasculitis have rarely been noted [6,7], it is more likely that a mild preexisting arteriosclerosis of the intracranial vessels rapidly progressed with the introduction of PI in antiretroviral therapy, so that the preexisting hyperlipidemia with tolerable cholesterol levels increased dramatically. Since so far only coronary heart disease is known to be triggered by these drugs [5,8], this is the first case to describe progressive cerebrovascular complications under PI. Thus, all patients with vascular risk factors receiving PI should be monitored carefully and PI medication reconsidered when possible.…”

HIV-associated vascular diseases: Structural and functional changes, clinical implications

“…However, shortly after HAART was introduced, several cases of acute coronary syndromes were reported [63][64][65][66]. These case-reports and the subsequent small series of patients with coronary events [67,68] quickly focused attention on the protease inhibitorinduced metabolic disorders, among which lipodystrophy [69], hyperlipidemia [70] and insulin resistance [71] were soon recognized.…”

“…However, although these metabolic changes affect most patients treated with HAART, the rate of induced coronary events occurring in patients has not grew, by far, proportionally. Data obtained from administrative and clinical records from healthcare organizations [75][76][77][78], retrospective cohort studies [67,72,79,80] and prospective observational studies [4,81] showed relatively stable rates of myocardial infarction over time ranging around 4 to 5 coronary events per 1000 patients-year treated, i.e. a 2-fold increase in magnitude when compared to a matched HIV-negative population (Table 3).…”

HAART-Associated Dyslipidemia Varies by Biogeographical Ancestry in the Multicenter AIDS Cohort Study

“…The overriding clinical concern is that these metabolic alterations may be associated with an increased risk of cardiovascular disease (CVD) and myocardial infarction in this population. [16][17][18][19][20][21][22][23][24] Previous studies associating dyslipidemia with specific drug combinations used in HAART have also shown that the extent of dyslipidemia tends to vary between self-reported racial populations. [25][26][27][28] Serum lipid levels, atherosclerosis, and CVD risk are all known to vary by race in the general population and polymorphisms in genes involved in cholesterol transport and metabolism may play a role in this variation.…”