Important note: Information in this article was accurate in 2005. The state of the art may have changed since the publication date.
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Wall Street Journal - February 24, 2005
Marilyn Chase at marilyn.chase@wsj.com
Jens Lundgren, a researcher at the University of Copenhagen, reported 277 heart attacks among 23,441 AIDS patients whose median age was 39. Dr. Lundgren presented his study at the 12th Annual Retrovirus Conference in Boston.
"You wouldn't expect myocardial infarcts [heart attacks] in that young a population," Dr. Lundgren said. While not recommending patients go off treatment, he said patients should try to alter other, more-modifiable lifestyle risk factors such as diet.
Dr. Lundgren stressed in a news conference that the cardiac risk is dwarfed by the huge life-expectancy gains that result from AIDS-drug cocktails. In 1995, before the era of modern antiviral cocktails began with the advent of protease inhibitors, the AIDS death rate was 23% a year; now it is 1.5% to 2% a year among treated patients, he said.
Healthier diets, cholesterol-lowering drugs and smoking cessation should be weighed for patients on AIDS treatment. "If you smoke, you increase risk 1 to twofold," Dr. Lundgren said. "If you quit, your heart forgives you."
Separately, American researchers working in Uganda questioned whether Uganda has lowered AIDS-virus prevalence through a program known as ABC -- abstinence, being faithful and condom use.
Maria Wawer, a researcher at the Columbia University Mailman School of Public Health, said the maturing of the epidemic and the death of patients also lower the population of infected people. Her team conducts an annual survey of 10,000 people in the southwestern Uganda district of Raika.
Uganda has received praise for its drop in the prevalence of the virus, which has fallen by half in key groups such as pregnant women. But there is disagreement over why, and how to interpret some social trends that seem to conflict.
"The declining HIV prevalence in Uganda over a decade is a real achievement," Dr. Wawer said. But along with adolescents reporting abstinence, she said that her studies also found an increase in the number of other people reporting multiple sexual partners.
Condom use may offset such risks, however. "There was a significant increase in the condom use, especially in casual relationships," she said, though she added there is a current shortage of condoms in Uganda.
But "the single greatest influence on prevalence of the virus is mortality," Dr. Wawer said, as patients succumb to the epidemic. So, she said, the "ABC" program of reducing infection should add a "D" for deaths.
Separately, the federal government's top AIDS research scientist, in an afternoon preview of a policy speech to be delivered last evening, warned the days of double-digit budget increases for AIDS are over for now, as the nation's health faces competing risks from bioterrorism, SARS and avian influenza.
"We have to face the challenge of making the most of scientific opportunities in drugs and vaccines" in a time of fiscal restraint, said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, a unit of the National Institutes of Health. But he denied a recent report that NIH would cut back its vaccine research. Indeed, when forced to set priorities, he said, "you do better research."
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