Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.
Newsday - February 14, 2003
Laurie Garrett, Staff Correspondent
The risk of a heart attack increases by 26 percent for each year patients remain on antiviral medicines, researchers announced yesterday at the 10th Conference on Retroviruses here.
A study of 23,468 HIV-positive, European men and women with a median age of 39 found that 126 had heart attacks - 36 of which were fatal, Dr. Friis Moller of the Copenhagen HIV Programme told the conference yesterday. While the actual number of heart attacks is relatively small, Moller said, each year the European HIV population is on the medications, risk of individual heart attack increases by 26 percent.
Moller's group concluded that being on antiretroviral drugs was a greater risk than elevated cholesterol levels - the traditional cause of cardiac disease.
Numerous other studies following thousands of patients in the United States and Europe noted sharp increases in cardiovascular diseases: heart attacks, clogged arteries, strokes and rapid heart rate. Dr. Uchenna Iloeje of Johns Hopkins School of Medicine, for example, followed 6,711 HIV patients for nearly three years, finding that 89 patients suffered severe cardiovascular disease - mostly heart attacks. Use of protease inhibitor drugs to block their HIV doubled their cardiac risk - the drugs raised risk more than did cigarette smoking. Another Hopkins study, surveying Baltimore's HIV population, found that those on medicines for HIV had a tenfold greater risk of a coronary or stroke compared with their age-matched, uninfected counterparts.
Some groups used sophisticated new ultrasound techniques for measuring the thickness of HIV patients' arteries - a way of seeing if they are getting atherosclerosis. One American team found no significant differences between age-matched HIV positive and negative individuals. But another, led by University of California in San Francisco cardiologist Priscilla Hsue, looked at 22 patients who had been HIV positive for a median of 11 years, all but one of whom were on antiretroviral drugs for an average of four years. Her patients had an average arterial buildup of 0.1 mm, "way more," she said, than that seen in elderly men who had already had heart attacks.
There is considerable controversy over why this is happening. Though many researchers blame the antiviral drugs, smoking guns are lacking. And Dr. Wafaa El-Sadr, head of AIDS treatment for Harlem Hospital, presented data on a pool of HIV patients from all over America showing that they are typically more obese than average Americans, smoke more and are more likely to have hypertension and diabetes - even if they aren't on anti-HIV medications.
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