Protease inhibitor exposure and increased risk of cardiovascular disease in HIV-infected patients

doi:10.1111/j.1468-1293.2005.00265.x

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Wiley InterScience

HIV Medicine

Volume 6 Issue 1, Pages 37 - 44

Published Online: 25 Jan 2005

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Original Research

Protease inhibitor exposure and increased risk of cardiovascular disease in HIV-infected patients

UH Iloeje ¹ , Y Yuan ² , G L'Italien ¹ , J Mauskopf ³ , SD Holmberg ⁴ , AC Moorman ⁴ , KC Wood ⁵ and RD Moore ⁶

¹ Pharmaceutical Research Institute, Bristol-Myers Squibb Company, Wallingford, CT, ² Pharmaceutical Research Institute, Bristol-Myers Squibb Company, Plainsboro, NJ, ³ Research Triangle Institute, Research Triangle Park, NC, ⁴ Centers for Disease Control and Prevention, Atlanta, GA, ⁵ Cerner Corporation, Vienna, VA and ⁶ Johns Hopkins University Medical Institute, Baltimore, MD, USA

Correspondence: Dr Uchenna H. Iloeje, 5 Research Parkway, Room EF 469, Wallingford, CT 06492, USA. Tel: 203 677 5755; fax: 203 677 5797; e-mail: Uchenna.iloeje@bms.com

KEYWORDS

antiretroviral therapy • cardiovascular disease • HAART • protease inhibitors • treatment complications

ABSTRACT

Objectives

To study the relationship between exposure to protease inhibitor (PI) therapy and increased risk of cardiovascular events in HIV-infected patients.

Methods

We estimated the risk of cardiovascular disease (CVD) events with PI exposure in a cohort of HIV-infected patients using a time-dependent Cox proportional hazards model adjusting for the major CVD risk factors. Only the first CVD event for each subject was counted.

Results

Of a total of 7542 patients, 77% were exposed to PIs. CVD event rates were 9.8/1000 and 6.5/1000 person–years of follow-up (PYFU) in the PI-exposed and nonexposed groups, respectively (P=0.0008). PI exposure ≥60 days was associated with an increased risk of CVD event [adjusted hazards ratio (HR_adj) 1.71; 95% confidence interval (CI) 1.08–2.74; P=0.03]. Results from a subgroup of patients aged between 35 and 65 years were similar (HR_adj 1.90; 95% CI 1.13–3.20; P=0.02). Other significant risk factors included smoking status, age, hypertension, diabetes mellitus and pre-existing CVD.

Conclusions

Patients exposed to PI therapy had an increased risk of CVD events. Clinicians should evaluate the risk of CVD when making treatment decisions for HIV-infected patients.

Received: 6 May 2004, accepted 10 September 2004

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1468-1293.2005.00265.x About DOI