More information on HIV, HAART and heart disease
Treatment with HAART has been accompanied by a decrease in cardiovascular-related deaths in HIV-positive US veterans according to a study published in the New England Journal of Medicine. However, HIV-positive people suffering a heart attack are more likely to experience a second severe coronary event according to another US study published in the 24th February 2003 edition of the Archives of Internal Medicine. In a retrospective study investigators examined the medical records of 36,766 HIV-positive patients who received care at US Veterans Affairs hospitals between January 1993 and June 2001. The results were first presented at the Ninth Conference on Retroviruses and Opportunistic Infections in 2001. When compared to the general profile of HIV-positive patients in the US, those receiving care at Veteran Affairs facilities were slightly older (82% over 35), and healthier (36.7% were asymptomatic and had a CD4 count of at least 500 cells/mm3 at diagnosis).Risk factors for cardiovascular disease including diabetes, high blood pressure, high blood lipids and smoking were present in a little under 24% of patients and 6.6% had received treatment for vascular disease. In total, 70.2% received anti-HIV therapy for an average of 15 months each. All patients were treated with a nucleoside analogue, 41% with a protease inhibitors and 25% a non-nucleoside analogue. Overall, there were 1,207 admissions for cardiovascular disease, 1,764 for cardiovascular or cerebrovascular disease and 2,006 deaths from these causes. However, after the introduction of HAART, the rate of admission for cardiovascular and cerebrovascular disease fell from 1.7 events per 100 patient-years in 1995 to 0.9 events per 100 patient-years in 2001. Death rates from any cause fell from 21.3 per 100 patient-years in 1995 to 5.0 per 100 patient-years in 2001. Neither the rate of admission or death because of cardiovascular conditions increased with increasing exposure to HAART. Where admission and death for cardiovascular and cerebrovascular disease did occur it was more likely to be amongst older patients with more advanced HIV disease and pre-existing cardiovascular or vascular disease.
Use of all classes of antiretroviral drug was found to be associated with a lower risk of death from all causes including cardiovascular and cerebrovascular disease. The investigators concluded that the use of HAART did not lead to increased rates of cardiovascular or cerebrovascular disease and fear of vascular disease should not deter the use of HAART (in the short-term at least). However, the extended prognosis of people receiving HAART means that longer-term observation is needed. However, a study comparing 24 HIV-positive patients experiencing heart attacks to 48 age and sex-matched HIV-negative controls found that the HIV-positive patients were more likely to suffer a second cardiac event within 15 months.
Between 1998 and 2000 all HIV-positive read more
