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hiv meds /CAD
Dec 17, 2006

I have been on meds since 1992. 1996-retrovir100mg tid,epivir 150mg bid, crixivan 400mg tid. 1998 1st stent was placed. 1999-zerit 20mg bid, epivir 150mg bid, sustiva 200mgtid. 2001added novir 100mg bid,. 2002 norvir was discontinued. Continues rest of above medications until 2003. Then Reyataz replaced Sustiva. 06/2005 1st attack kindey stones and continued above meds. 09/2005 2nd stent right coronary artery. 05/06 2 episodes in 1 wk kidney stones. stone report caused by reyataz. Reyataz stopped and continued on norvir 100mg OD Lexiva 1400mg OD and Truvada daily. 3rd stent 08/06. I would like to know what would be the best treatment at this point with CAD secondary to hiv meds . Last genotype08/06 sensitive to all. I am also on liptor40mg/od Tricor OD, Plavix 75/OD ASA 325/OD. please advise. Thank you

Response from Dr. Pierone

Hello, and thanks for posting.

Your situation is not unusual since people are living longer with HIV infection and the risk of coronary artery disease increases with age. There is also an increased risk of coronary artery disease related to use of HIV medications, particularly when protease inhibitors are used. Since protease inhibitors are associated with metabolic changes that promote atherosclerosis, the first question is whether a switch to a NNRTI such as Viramune would be prudent. If there is no evidence of drug-resistant virus then this may be a possible tactic. But the risk of Viramune associated liver toxicity is higher when the CD4+ lymphocyte cell count is higher than 250 in women and 400 in men.

The other crucial strategy to prevent the progression of coronary artery disease involves reduction of the other known vascular risk factors. Smoking is the greatest cardiovascular evil and smoking cessation is by far and away the most important change that anyone with heart disease needs to make. Exercise, especially aerobic conditioning, is an important component of a preventive regimen. Many people with coronary artery disease are under the impression that exercise may be detrimental and bring on a heart attack, but regular exercise significantly lowers the risk of cardiovascular complications. Of course, a well-balanced, heart healthy diet should also be part of the plan. There has been accumulating evidence that omega 3 oils (fish oil and flaxseed oil) lower the risk of heart attack and stroke so at least 1 gram of omega 3 should be a taken daily. Aggressive cholesterol lowering with a goal to get the LDL cholesterol under 70 mg/dl should be implemented as well. In addition, triglycerides should be brought under 150 mg/dl. Blood pressure should also be tightly controlled (under 130 systolic) to reduce the risk of future events.

These are generic recommendations for anyone with coronary artery disease, but your situation might dictate additional action so a consultation with a cardiologist with an interest in cardiovascular prevention (rather than stent placing) would also be a good idea.

Let us know how things go and best of luck!



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