[52] RISKS OF CARDIOVASCULAR DISEASE ASSOCIATED WITH HIGHLY ACTIVE ANTIRETROVIRAL THERAPY AMONG PERSONS TREATED FOR HIV/AIDS

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] RISKS OF CARDIOVASCULAR DISEASE ASSOCIATED WITH HIGHLY ACTIVE ANTIRETROVIRAL THERAPY AMONG PERSONS TREATED FOR HIV/AIDS

[AUTHOR(S):] AR Levy¹, B Sobolev¹, RS Hogg^1,2, U Iloeje³, J Mukherjee³, B Yip², M Harris², MV O’Shaughnessy² and JS Montaner²
¹Department of Health Care and Epidemiology, University of British Columbia (BC); ²BC Centre for Excellence in HIV/AIDS; and ³Bristol-Myers Squibb, Canada

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. 52
Antiviral Therapy 2003; 8(Suppl. 1):S196

[ABSTRACT:] Background: Although abnormal lipid profiles have been reported among persons treated with highly active antiretroviral therapy, the evidence regarding the risk of cardiovascular disease has been equivocal.

Objective: To estimate the association between use of protease inhibitors (PI), and non-nucleoside reverse transcriptase inhibitors (NNRTI) and the risk of hospitalization or death from cardiovascular disease, in a population-based cohort.

Methods: We included all antiretroviral naïve HIV-infected persons in British Columbia (BC), Canada, who initiated triple therapy after August 1, 1996. Subjects were followed until March 31, 2001 for a hospitalization record or death certificate with a diagnostic code for myocardial infarction, stable or unstable angina or cardiovascular disease. Information was linked on use of antiretroviral medications and all hospitalizations and deaths the cohort using administrative data sources. Use of PIs and NNRTIs were treated as time-dependent covariate in a Cox proportional hazards model, after adjusting for age, sex, baseline CD4 count, year of entry and prior cardiovascular disease. Ninety percent confidence intervals (90% CI) are presented due to the exploratory nature of these analyses.

Results: All 2 616 subjects in the cohort received nucleoside reverse transcriptase inhibitors (NRTI); of these, 10% received only a nucleoside analogue, 40% also received PI, 24% also received NNRTI and 26% also received both PI and NNRTI. Over a mean of 3.0 years of follow-up, 24 subjects were hospitalised or died with evidence of cardiovascular disease. After adjusting for covariates, the hazard ratio (HR) during periods of exposure to PIs alone was 3.9 (90% CI: 1.0, 15.2), during periods with exposure NNRTIs alone 1.6 (90% CI: 0.3, 10.5), and periods with both PI and NNRTI exposure, 2.2 (90% CI: 0.5, 9.6).

Conclusions: This population-based analysis showed that the risk of cardiovascular disease may be increased when HIV-infected subjects were using PIs. The true association is likely to be stronger than shown here because misclassification of exposure likely reduced in magnitude of the association.

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