Cardiovascular and Cerebrovascular Events in Patients Treated for Human Immunodeficiency Virus Infection

Metabolic abnormalities associated with HIV infection, including dysglycemia and hyperlipidemia, are increasingly prevalent, and there is concern about the possibility of an association with accelerated cardiovascular and cerebrovascular disease. In the current study, the relation between the risk of such disease and the use of antiretroviral therapy was evaluated.

Researchers conducted a retrospective study of the risk of cardiovascular disease among the 36,766 patients who received care for HIV at Veterans Affairs facilities between January 1993 and June 2001. Compared with typical patients with HIV in the United States, members of the VA cohort receiving services were more likely to be black (52.4 percent) and far more likely to be men (98.1 percent). The cohort was also slightly older (17.6 percent were less than 35 years old) and had less severe illness (36.7 percent were asymptomatic and had more than 500 CD4 cells/mm3 at diagnosis). A total of 23.9 percent had been previously treated at a VA facility for diabetes, hypertension, hyperlipidemia, or smoking, and 6.6 percent had been treated at a VA facility for vascular disease.

For antiretroviral therapy, 70.2 percent of patients received nucleoside analogues (NA), 41.6 percent received protease inhibitors (PI), and 25.6 percent received nonnucleoside reverse transcriptase inhibitors (NNRTI) for a median of 17 months, 16 months, and 9 months, respectively. Approximately 1,000 patients received combination therapy with a PI for at least 48 months, and approximately 1,000 patients received combination therapy with an NNRTI for at least 24 months.

Overall, there were 1,207 admissions for cardiovascular disease, 1,764 admissions for cardiovascular or cerebrovascular disease, and 2,006 admissions for or deaths from cardiovascular or cerebrovascular disease. Between 1995 and 2001, the rate of admissions for cardiovascular disease decreased from 1.7 to .9 per 100 patient-years, and the rate of death from any cause decreased from 21.3 to 5 deaths per 100 patient-years. Patient-level regression analyses indicated that there was no relation between the use of NAs, PIs, or NNRTIs and the hazard of cardiovascular or cerebrovascular events. However, the use of antiretroviral drugs was associated with a decreased hazard of death from any cause.

The fear of accelerated vascular disease need not compromise antiretroviral therapy over the short term, researchers concluded. Large increases in antiretroviral drug use by a large population of HIV-positive VA patients during the second half of the 1990s were accompanied by small decreases -- rather than the feared increases -- in the rates and hazards of cardiovascular and cerebrovascular events. However, the researchers cautioned that prolonged survival among HIV-infected patients means that longer-term observations and analyses are required.

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