HIV Drug Linked to Heart Disease

People with HIV who take protease inhibitors run a measurably higher risk of developing heart disease, researchers reported Wednesday at the 14th International AIDS Conference. A large Italian study followed 1,200 HIV-infected antiretroviral naïve people who were randomly assigned a drug combination either with or without a protease inhibitor for over three years. All were younger than 48 (with an average age of 35); most were men; and 87 percent smoked at least 15 cigarettes a day.

There were 23 cases of new-onset coronary heart disease in the group taking protease inhibitors (12 had heart attacks, the rest experienced angina). In the group that did not take a protease inhibitor, there were only two.

The factors most associated with heart disease were smoking; the changes in body fat seen in many people taking antiretrovirals; elevated cholesterol and triglycerides; and an elevation of a blood-clotting protein called fibrinogen, which often occurs in smokers.

Giorgio Barbarini, an epidemiologist at University La Sapienza in Rome, who presented the research, said it appears that protease inhibitors can accelerate the emergence of heart disease in people who are already prone to it. He noted that those taking a protease inhibitor had a higher rate of heart attack than what is seen in Italians of the same age. Whether that was because of the HIV medicines, HIV infection itself or behavioral characteristics of this particular HIV-infected group (such as its very high rate of smoking) is uncertain.

Physicians and patients have noticed that many users of protease inhibitors experience rises in cholesterol, triglycerides and blood sugar -- all known risk factors for heart disease. Previous studies of whether people taking the medicines actually have higher rates of heart disease than people not taking them have given contradictory answers.

"Physicians who are prescribing protease inhibitor-containing regimens should do a careful cardiological screening on the patients," Barbarini said. Danish physician Jens D. Lundgren noted the heart attacks were all late in the study and that, compared to the benefits of protease inhibitors, the absolute risk of a heart attack was very small. In some groups of HIV-infected populations, their use has cut death rates from 25 percent a year to 2 percent a year.

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