Sixth International Congress Drug Therapy in HIV Infection 17-21 November, 2002 Glasgow, UK

Whether anti-HIV drugs accelerate the atherosclerotic process and thereby enhances the risk of coronary heart disease (CHD) and stroke remains a controversial question. Drugs from all three classes may increase the plasma concentration of cholesterol, LDL-cholesterol and triglycerides. This effects patients variably, and marked variations exists within each class. PI’s also increases insulin resistance and may damask diabetes mellitus. Being known proatherogenic in the background population, none of these markers have been validated for secondary atherosclerosis -- i.e. atherosclerosis induced by drugs (not for HIV-related drugs nor for any other type of drugs associated with an increased risk of CHD). Furthermore, if the association between drug-induced dyslipidaemia/insulin resistance and CHD do exist, the "lag time" from these drugs are first used until the risk of CHD starts to accelerate is unknown -- but is essential in determining the most rational clinical management. The reverse lag time, i.e. time interval from reduction of cholesterol by statins until risk of CHD starts to decrease is 2-4 years. In congenital dyslipidaemia atherosclerotic vascular disease starts to emerge after at least 10 years. Other proatherogenic factors affect the lag time in that situation and will likely as do so in HIV. Hence, there is a need to generate scientific documentation to address the three core questions: 1. Is there an association between exposure time to anti-HIV drugs and the risk of CHD?, 2. If so, when does the risk of CHD start to accelerate after commencing these drugs?; 3. Which factors influence the risk of CHD in patients on anti-HIV drugs?. There are several studies already presented to address these questions, and some of them suggest an association whereas others do not. A randomised trial was presented recently also suggesting that an association exists, but the integrity of that trial has been called in to question. Updates on these studies and of the multicontinental D:A:D study will be presented.

Presenting author: Jens Lundgren

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1 Copenhagen HIV Program, University of Copenhagen, Denmark.

2002-11-17
PL9-2

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