Impact of Individual Antiretroviral Drugs on the Risk of Myocardial Infarction in Human Immunodeficiency Virus-Infected Patients

The authors noted that the role of exposure to specific antiretroviral drugs on the risk of myocardial infarction (MI) in HIV-positive patients has been a subject of debate in medical literature.

"To assess whether we confirmed the association between exposure to abacavir and risk of [MI] and to estimate the impact of exposure to other nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs) and non-NRTIs on risk of MI, we conducted a case-control study nested within the French Hospital Database on HIV," the researchers wrote.

The study's 289 case subjects were patients who had a prospectively recorded first definite or probable MI between January 2000 and December 2006. Up to five controls (a total of 884 individuals) -- matched for age, sex, and clinical center -- were selected at random with replacement among patients with no history of MI already enrolled in the database when MI was diagnosed in the corresponding case. To adjust for potential confounders, conditional logistic regression models were used.

The results showed that short-term/recent exposure to abacavir was associated with an increased risk of MI in the overall sample (odds ratio [OR] 2.01; 95 percent confidence interval [CI] 1.11-3.64) but not in the subset of matched cases and controls (81 percent) who did not use cocaine or intravenous drugs (1.27, 0.64-2.49). Except for saquinavir, cumulative exposure to all PIs was associated with an increased risk of MI significant for amprenavir/fosamprenavir with or without ritonavir (OR, 1.53; 95 percent CI 1.21-1.94 per year) and lopinavir with ritonavir (1.33; 1.09-1.61 per year). Exposure to all non-NRTIs was not found to be associated with MI risk.

"The risk of MI was increased by cumulative exposure to all the studied PIs except saquinavir and particularly to amprenavir/fosamprenavir with or without ritonavir and lopinavir with ritonavir, whereas the association with abacavir cannot be considered causal," the authors concluded.

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