Protease inhibitor exposure and increased risk of cardiovascular disease in HIV-infected patients.
OBJECTIVE
To study the relationship between exposure to protease inhibitor (PI) therapy and increased risk of cardiovascular events in HIV-infected patients.


METHODS
We estimated the risk of cardiovascular disease (CVD) events with PI exposure in a cohort of HIV-infected patients using a time-dependent Cox proportional hazards model adjusting for the major CVD risk factors. Only the first CVD event for each subject was counted.


RESULTS
Of a total of 7542 patients, 77% were exposed to PIs. CVD event rates were 9.8/1000 and 6.5/1000 person-years of follow-up (PYFU) in the PI-exposed and nonexposed groups, respectively (P=0.0008). PI exposure >/=60 days was associated with an increased risk of CVD event [adjusted hazards ratio (HR(adj)) 1.71; 95% confidence interval (CI) 1.08-2.74; P=0.03]. Results from a subgroup of patients aged between 35 and 65 years were similar (HR(adj) 1.90; 95% CI 1.13-3.20; P=0.02). Other significant risk factors included smoking status, age, hypertension, diabetes mellitus and pre-existing CVD.


CONCLUSIONS
Patients exposed to PI therapy had an increased risk of CVD events. Clinicians should evaluate the risk of CVD when making treatment decisions for HIV-infected patients.
Iloeje
U H
UH
Pharmaceutical Research Institute, Bristol-Myers Squibb Company, Wallingford, CT, USA.
Yuan
Y
Y
L'italien
G
G
Mauskopf
J
J
Holmberg
S D
SD
Moorman
A C
AC
Wood
K C
KC
Moore
R D
RD
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000209:etiology; D003925:Diabetic Angiopathies / Q000139:chemically induced; D004812:Epidemiologic Methods; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000150:complications; D008875:Middle Aged; D012907:Smoking / Q000009:adverse effects
D017320:HIV Protease Inhibitors