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and Hepatitis.com Coverage of the
18th Conference on Retroviruses and
Opportunistic Infections (CROI 2011)
February 27 - March 2, 2011, Boston, MA
Studies Shed Further Light on Cardiovascular Disease among People with HIV
As HIV treatment proves increasingly effective, at least in developed countries, attention has shifted to the long-term consequences of both HIV disease and its treatment.
The impact of HIV and antiretroviral therapy on cardiovascular health is of particular interest, as heart disease remains the biggest health issue in the U.S. This year's CROI featured several presentations covering cardiovascular disease and HIV.
HIV and MI Risk
Evidence from the SMART treatment interruption study and elsewhere indicate that HIV infection may lead to an increased risk of myocardial infarction (MI), or heart attack. Two oral presentations at CROI dealt with this topic.
Matthew Freiberg from the University of Pittsburgh (abstract 809) presented an analysis of acute MI risk in the Veterans Aging Cohort Study. This study compared over 27,000 people with HIV to a matched group over 55,000 HIV negative veterans, followed from 2003 through 2008. The cohort is largely male and the average age was 49 years. Overall, the HIV negative veterans appeared to be at increased risk of MI due to some traditional risk factors, particularly diabetes and hypertension.
These studies suggest that HIV infection increases a person's risk of cardiovascular disease including MI. But there is some evidence that effective treatment of HIV may reduce that risk. There is also evidence that advanced HIV disease contributes to a person's risk of MI.
Abacavir and MI Risk
Abacavir (Ziagen, also in the Epzicom and Trizivir combination pills) is a widely used component of first line antiretroviral treatment. In 2008, an analysis of the D:A:D cohort found that abacavir was associated with an increased risk of MI.
Results from other studies, however, have proved conflicting. For example, GlaxoSmithKline, abacavir's manufacturer, performed an analysis of 54 studies in which abacavir was used and found no increased risk of MI. An analysis of the SMART study, in contrast, found a 4-fold increased risk of MI among those taking abacavir.
In a poster
presentation at this year's CROI, Xiao Ding of the U.S. Food and Drug
Administration (abstract 808) presented a meta-analysis of 26 randomized
controlled clinical trials (RCTs) in which abacavir was used. The analysis
included almost 5000 participants, approximately 75% of the men. The
researchers divided the studies into those sponsored by the manufacturer,
the National Institutes of Health (NIH), and academic institutions.
The results from this analysis are likely to fuel the ongoing controversy about abacavir and risk of MI. The controversy includes the classification of abacavir-containing regimens in the DHHS federal HIV treatment guidelines. The current guidelines classify regimens containing tenofovir/emtricitabine (Truvada) as "preferred" and those containing abacavir as "alternative." Abacavir was downgraded based in part on the D:A:D and SMART MI findings.
M Freiberg, K McGinnis, A Butt, et al. HIV is associated with clinically confirmed myocardial infarction after adjustment for smoking and other risk factors. 18th Conference on Retroviruses and Opportunistic Infections. Boston. February 27-March 2, 2011. Abstract 809.
M Goetz, S Brown, KA Oursler, et al. Contribution of immunodeficiency to CHD: Cohort study of HIV+ and HIV- Kaiser Permanente members. 18th Conference on Retroviruses and Opportunistic Infections. Boston. February 27-March 2, 2011. Abstract 810.
X Ding, E Andraca-Carrera, C Cooper, et al. No association of myocardial infarction with ABC use: an FDA meta-analysis. 18th Conference on Retroviruses and Opportunistic Infections. Boston. February 27-March 2, 2011. Abstract 808.