[procaare] Atherosclerosis Risk Increased with HIV

[John James <procaare@healthnet.org>]

Atherosclerosis Risk Increased with HIV; Treatment Effects Unclear
John S. James
***************

Summary: A major report on heart disease and HIV found that HIV infection itself is
associated with increased risk, independently of other factors like age, cholesterol, and
smoking. Another major report did find differences among antiretrovirals, but the
information is hard to summarize.
* * *

An important study by cardiologists, endocrinologists, and HIV physicians found more
atherosclerosis in persons with HIV, and much faster progression, than in the general
population.(1) The measurement used in this study -- increasing thickness of the carotid
artery, determined non-invasively by ultrasound examination -- is known to be a predictor
of strokes and heart attacks in other populations. But this study could not tell how much
of the increased risk is due to HIV itself, and how much is due to metabolic abnormalities
caused by protease inhibitors or other HAART treatment in some patients.(2)

Age, LDL cholesterol, and smoking (cigarette pack-years) were strong predictors of
atherosclerosis in the 148 persons with HIV who were studied; Latino race and high blood
pressure were weaker predictors. Other risks like diabetes would not have shown up in this
study because of the small number of volunteers affected. When matched controls were added
to the analysis, HIV infection itself was a strong predictor of greater atherosclerosis,
independent of other factors.

The authors gave some practical clinical suggestions at the end of the article: "Although
randomized trials have not been done to demonstrate that treatment of risk factors reduces
events in HIV-infected patients, it seems reasonable to extrapolate from other populations
and to recommend aggressive control of risk factors. Smoking is particularly important
because of its high prevalence. Hypertension should be treated. LDL cholesterol should be
reduced to low levels, and hypertriglyceridemia should be controlled. If lipids are
difficult to control, antiretroviral medication that may be contributing to lipid
elevation should be reviewed and changed to medication with fewer lipid effects. Until
further data are available, treating to the National Cholesterol Education Panel
guidelines(3) for patients with established vascular disease or diabetes seems prudent."

The researchers are from San Francisco General Hospital, and the Department of Medicine,
University of California, San Francisco. The volunteers were mostly recruited from the
University of California, San Francisco Study of the Consequences of the Protease
Inhibitor Era (SCOPE) study.

References
(1) PY Hsue, JC Lo, A Franklin, AF Bolger, JN Martin, SG Deeks, and DD Waters. Progression
of Atherosclerosis as Assessed by Carotid Intima-Media Thickness in Patients With HIV
Infection. Circulation. 2004; volume 109, pages 1603-1608, April 6 (published online
before print, March 15). The abstract is free at:
http://www.circulationaha.org - but the full article costs $15 online for nonsubscribers.

(2) Another recent study looked at triglyceride and cholesterol changes associated with
different antiretrovirals, in a major analysis of data from over 7,000 HIV patients in 11
previously established cohorts. Some of its findings will be useful for particular
patients, but overall it is hard to interpret this article. Reuters Health published a
summary; you can find it on the AIDSMEDS site, at:
http://www.aidsmeds.com/news/20040323clin001.html

Here is the reference for the original article:
E Fontas, F van Leth, CA Sabin, and others. Lipid profiles in HIV-infected patients
receiving combination antiretroviral therapy: Are different antiretroviral drugs
associated with different lipid profiles? Journal of Infectious Diseases. March 15, 2004;
volume 189, pages 1056-1074.

(3) Information on the National Cholesterol Education Program is available at:
http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm

***
Copyright 2004 by John S. James, www.aidsnews.org


Cross-posted from PWHA-NET (pwha-net@eforums.healthdev.org)
May 11, 2004

--
To send a message to ProCAARE, write to: procaare@healthnet.org
To subscribe or unsubscribe, write to: majordomo@healthnet.org
in the body of the message type: subscribe procaare OR unsubscribe procaare
To contact a person, send a message to: procaare-help@healthnet.org
Information and archives: http://www.procaare.org

The views presented in ProCAARE do not necessarily reflect the opinions of
SATELLIFE  (http://www.healthnet.org), the Harvard AIDS Institute
(http://aids.harvard.edu), or Health & Development Networks
(http://www.hdnet.org), unless otherwise stated. The reader assumes all
responsibilities in using information posted or archived by ProCAARE.
Reproduction is welcomed, provided ProCAARE and procaare@healthnet.org
are quoted, and SATELLIFE is informed of usage.