HIV Treatment Bulletin - Vol. 6, No. 1, December 2004 / January 2005
Graham McKerrow, HIV i-Base

Coronary artery bypass graft (CABG) is a feasible and safe procedure in HIV-positive patients, conclude Boccara and colleagues at the French Italian Study on Coronary artery disease in AIDS patients (FRISCA-2). There was no difference in immediate postoperative outcomes between HIV-positive and HIV-negative patients. However. long-term follow-up showed higher rates of major adverse cardiac events (MACE) was significantly higher in HIV-positive patients due to an increased rate of repeat revascularisation procedure (reCABG and percutaneous coronary intervention [PCI]).

From 1997 to 2003 inclusive, researchers compared 22 HIV-positive and 42 HIV-negative control patients matched for age and gender who underwent CABG. They compared baseline characteristics, immediate results and clinical outcome (MACE: death from any cause, myocardial infarction, re-intervention and/or PCI) at 34 months.

Cardiovascular risk factors were nearly identical in both groups with a higher rate of hypercholesterolaemia (96% versus 74%, p=0.045) and hypertriglyceridaemia (82% versus 45%, p=0.005) in HIV-positive patients. Obesity was more frequent in the control group (33% versus 0%, p=0.001).

In the HIV-positive group, mean CD4 count was lower post-operation compared to beforehand (427 ± 162 vs 503 ±200 cells/mm³) but this was without clinical significance in the follow-up. Coronary multivessel disease (> 2 vessel disease) was present in nearly all patients (96% HIV-positive and 93% HIV-negative). Left Ventricular Ejection Fraction and mean number of grafts were also similar in the 2 groups (55%±10 versus 50%±14, respectively.

After one month, the rate of post-operative death, MI, stroke, mediastinitis, and re-intervention was identical in both groups. However, at 34 ±20 months follow-up, rate of occurrence of first MACE was higher in HIV-positive group. The only predictor of MACE at follow-up was HIV infection itself with a hazard ratio of 6.3 (95%CI 2.2-17.9, p=0.001).

Ref: Boccara F, Cohen A, Odi G et al. Coronary artery bypass graft in HIV-infected patients. A multicentre case control study. 6th Lipodystrophy Workshop (6th IWADRLH), Washington. Antiviral Therapy 2004; 9:L65 Abstract 115.

041210
IB050601-10

©2004. I-BASE HIV Treatment Bulletin. Permission to reproduce courtesy of HIV i-Base, Third Floor East, Thrale House, 44-46 Southwark Street, London SE1 1UN - T: +44 (0) 20 7407 8488 F: +44 (0) 20 7407 8489

AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, Elton John AIDS Foundation, Bridgestone / Firestone Trust, the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2004. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2004. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content.