Premature atherosclerosis in HIV positive patients and cumulated time of exposure to antiretroviral therapy (SHIVA study).
BACKGROUND
With the advent of antiretroviral therapy regimens in HIV positive patients, it is crucial to consider their long-term benefits to risk ratios. The responsibility of treatment in premature atherosclerosis is not clear. Thus, the aim of this study is to evaluate the impact of exposure to reverse transcriptase inhibitors (nucleosidic and non-nucleosidic) and to protease inhibitors on the cardiovascular status of an entire hospital based cohort of patients.


METHODS
154 patients were included. Using a linear analysis, we sought an association between the cumulative time of exposure to these three classes of antiretroviral drugs and the carotid intima-media thickness measured by ultrasonography and a cardiovascular composite score.


RESULTS
The study confirms premature atherosclerosis, which not only correlates with the usual risk factors, such as triglyceride level, but also with protease inhibitor exposure, especially that of lopinavir. Nevertheless as regards current drug exposure, the clinical impact was low: five clinical complications of atherosclerosis and only one out of 35 scintigraphic and ECG exercise tests warranted a coronary angiography which was negative.


CONCLUSIONS
These data should not lead to the rejection of protease inhibitors but should strengthen the prevention of cardiovascular diseases as an integral part of the management of HIV patients.
de Saint Martin
Luc
L
CHU de La Cavale Blanche, EA 3878, GETBO, Brest University Hospital, 29609 Brest cedex, France. luc.desaintmartin@chu-brest.fr
Vandhuick
Olivier
O
Guillo
Philippe
P
Bellein
Véronique
V
Bressollette
Luc
L
Roudaut
Nathalie
N
Amaral
Antonio
A
Pasquier
Elisabeth
E
D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D050197:Atherosclerosis / Q000209:etiology / Q000473:pathology*; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis; D017536:Carotid Artery, Common / Q000473:pathology; D015331:Cohort Studies; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D006679:HIV Seropositivity / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008055:Lipids / Q000097:blood; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D017539:Tunica Intima / Q000187:drug effects / Q000473:pathology; D017540:Tunica Media / Q000187:drug effects / Q000473:pathology
D044966:Anti-Retroviral Agents; D017320:HIV Protease Inhibitors; D008055:Lipids; D018894:Reverse Transcriptase Inhibitors