[33] CLINICAL CHARACTERISTICS AND MID-TERM PROGNOSIS OF ACUTE CORONARY SYNDROME IN HIV-INFECTED PATIENTS ON ANTIRETROVIRAL THERAPY: A 3-YEAR FOLLOW-UP STUDY

5th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV

8–11 July 2003, Le Meridien Montparnasse, Paris, France

CLINICAL CHARACTERISTICS AND MID-TERM PROGNOSIS OF ACUTE CORONARY SYNDROME IN HIV-INFECTED PATIENTS ON ANTIRETROVIRAL THERAPY: A 3-YEAR FOLLOW-UP STUDY

Antiviral Therapy 2003; 8:L28 (abstract 33)

F Boccara¹, C Smadja¹, L Djaouti¹, O Belliard¹, W Rozenbaum² and A Cohen¹
¹Saint Antoine University Hospital, Paris, France; and ²Tenon University Hospital, Paris, France

OBJECTIVE: To determine the prognosis of acute coronary syndrome (ACS) in HIV-infected patients.

METHODS: This preliminary report evaluates the clinical characteristics and follow-up profile (37.5 ±15 months) of ACS in 20 HIV-infected patients (mean age 44 ±8 years). Eighteen patients were on antiretroviral therapy, including protease inhibitors (PIs) in 13 patients (mean duration 19 ±13 months). All had a coronary angiogram performed at 3 ±48 h after the onset of symptoms. Median CD 4 cell count was 362 ±175/mm³ and viral load was 9000 ±23700 copies/ml in our cohort.

RESULTS: Thirteen patients had a first episode of ST segment elevation ACS and five had non-ST segment elevation ACS. Of 20 patients, 15 (75%) had at least two cardiovascular risk factors. Tobacco consumption (80%) and hypercholesterolaemia (50%) were the most frequent cardiovascular risk factors. Seven patients had lipodystrophy syndrome prior to ACS. No patients died during initial hospitalization; four patients were treated with thrombolysis; two had primary coronary angioplasty; and seven had secondary coronary angioplasty. No patients received statin therapy prior to ACS. At follow-up (mean 37 ±15 months), 10 patients (50%) had 18 cardiovascular events: one cardiovascular death, seven episodes of recurrent myocardial ischemia in four patients, three pulmonary oedemas in two patients and seven revascularization procedures in five patients. Six of 10 patients normalized their cholesterol level and the average low-density lipoprotein (LDL)-cholesterol level went down from 144 ±24 mg/dl to 125 ±21 mg/dl after diet and drug therapy. Only two of 13 patients normalized their triglyceride level. Six of 16 patients stopped smoking. Our cohort is at higher risk of cardiovascular events at mid-term follow-up as compared to non-HIV patients less than 45 years old reported in previous series.

CONCLUSION: This preliminary report highlights the risk of ACS and related complications in HIV-infected patients and raises questions regarding the implication of antiretroviral treatment. In order to evaluate the relationship between antiretroviral treatment, HIV disease and incidence and prognosis of ACS in HIV-infected patients, controlled and prospective studies are required.

Presenting author: F Boccara

2003-07-08
33

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