title: Impact of dyslipidemia associated with Highly Active Antiretroviral Therapy (HAART) on cardiovascular risk and life expectancy.
abstract: We investigated the effect of dyslipidemia associated with highly active antiretroviral therapy on cardiovascular risk and life expectancy among patients who had the human immunodeficiency virus. Dyslipidemia estimates were based on results from a phase 2 randomized trial that compared lipid changes after 32 weeks of therapy with atazanavir with those with nelfinavir (each in combination with stavudine and lamivudine). The resultant increased coronary risk was estimated using Framingham risk equations, and change in life expectancy (after adjustment for mortality due to human immunodeficiency virus) was based on the cardiovascular life expectancy model, which is based on a published Markov's model. Levels of total cholesterol and low-density lipoprotein cholesterol increased significantly more among patients who used nelfinavir (+24% and +28%) than among those who used atazanavir (+4% and +1%). This dyslipidemia increased the risk of coronary disease by 50% over 10 years. The absence of dyslipidemia was estimated to preserve life expectancy 0.15 to 1.53 additional years depending on a patient's age, gender, and other risk factors. There are increasing reports of dyslipidemia and cardiovascular events associated with highly active antiretroviral therapy. Significant increases in blood lipid levels observed with some protease inhibitors are associated with an increase in calculated 10-year coronary risk. Accordingly, minimizing dyslipidemia associated with highly active antiretroviral therapy may preserve life expectancy among adults who have the human immunodeficiency virus.
authors.affiliation: Centre for the Analysis of Cost-Effective Care, Divisions of General Internal Medicine and Clinical Epidemiology, The Montreal General Hospital, Department of Medicine, McGill University, Montreal, Quebec, Canada. steven.grover@mcgill.ca
authors.forename: Steven A
authors.initials: SA
authors.lastname: Grover
authors.forename: Louis
authors.initials: L
authors.lastname: Coupal
authors.forename: Norbert
authors.initials: N
authors.lastname: Gilmore
authors.forename: Jayanti
authors.initials: J
authors.lastname: Mukherjee
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D000069446:Atazanavir Sulfate; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced / Q000150:complications* / Q000188:drug therapy; D019259:Lamivudine / Q000008:administration & dosage; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D019888:Nelfinavir / Q000008:administration & dosage; D009842:Oligopeptides / Q000008:administration & dosage; D011725:Pyridines / Q000008:administration & dosage; D012307:Risk Factors; D018119:Stavudine / Q000008:administration & dosage
chemical_list: D009842:Oligopeptides; D011725:Pyridines; D019259:Lamivudine; D000069446:Atazanavir Sulfate; D018119:Stavudine; D019888:Nelfinavir