AEGiS-07CROI: Do protease inhibitors increase the risk for coronary heart disease among HIV-positive patients? Additional follow-up.

7th Conference on Retroviruses and Opportunistic Infections

San Francisco, CA - January 30 -February 4, 2000

DO PROTEASE INHIBITORS INCREASE THE RISK FOR CORONARY HEART DISEASE AMONG HIV-POSITIVE PATIENTS? ADDITIONAL FOLLOW-UP.

Conf Retroviruses Opportunistic Infect 2000 Jan 30-Feb 2; 7:81 (abstract no. 33)

D. Klein¹, L. Hurley², And S. Sidney²
¹Kaiser Permanente Med. Care Program, Hayward, CA; and ²Kaiser Fndn. Res. Inst., Oakland, CA

BACKGROUND: Concern has been raised over increased risk of coronary heart disease (CHD) in patients receiving protease inhibitor (PI) therapy, perhaps consequent to higher lipid levels in patients on PIs and/or a direct thrombogenic effect of these drugs.

METHODS: Kaiser Permanente Northern California (KPNC), a not-for-profit HMO, cares for 2.8 million members. HIV positive (+) Health Plan (HP) members were followed in the period 1/1/96 to 6/30/99 and hospital events for CHD (ICD9 codes 410-414, primary discharge diagnosis) among the HIV+ cohort were identified. Patients with CHD events prior to the start of follow-up were excluded. Follow-up started 1/1/96 or at HIV diagnosis (whichever came later) and continued through the earliest of HP termination, death, or end of observation (6/30/99). Person-time was assigned to two categories: non-PI follow-up - days of follow-up which preceded any PI use; or PI follow-up - days of follow-up following the first use of a PI, if any. Patients could contribute time to both non-PI and PI follow-up. Age-adjusted (1990 census) incidence rates and confidence intervals (CI) were calculated overall and separately for non-PI and PI follow-up. CHD risk factors were assessed among members with events.

RESULTS: Overall, 4526 HIV patients contributed a mean of 2.6 person-years of follow-up and experienced 42 CHD events, representing an increase of 2500 person-years and 15 new events over what has been previously reported. 4518 patients contributed a mean of 1.4 person-years of non-PI follow-up and had 20 CHD events. 2661 patients contributed a mean of 2.0 person-years of PI follow-up and had 22 CHD events. Age-adjusted CHD hospitalization rates per 1000 person-years and 95% CIs were 5.6 (3.5, 7.6) overall, 5.5 (2.5, 8.4) for non-PI follow-up and 5.7 (2.8, 8.5) for PI follow-up. Multiple risk factors for CHD were present in our patients: hypertension (59%), hypercholesteremia (54%), diabetes mellitus (15%) and current smoker (41%).

CONCLUSION: In our ongoing study, our data continue to suggest that PI use does not increase short-term risk for CHD. As in all patients with multiple risk factors for CHD, risk reduction management is warranted.

Keywords: AEGIS, Risk, Coronary Disease, Risk Factors, HIV Infections, Protease Inhibitors, Hypercholesterolemia, HIV Protease Inhibitors, HIV Seropositivity, Incidence, California, Commonwealth of Independent States, Human, AIDS

2000-01-30
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Copyright © 2000 - Foundation for Retrovirology and Human Health (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Foundation for Retrovirology and Human Health. Licensed from National Library of Medicine.