Dyslipidemia Significantly Increases Cardiac Risk in HAART Patients

By David Douglas

Dyslipidemia associated with highly active antiretroviral therapy (HAART) in HIV patients may increase the risk of coronary disease by as much as 50%, Canadian and US researchers estimate.

Lead investigator Dr. Steven A. Grover told Reuters Health that "there is increasing evidence that multi-drug antiretroviral therapy that includes protease inhibitors is often associated with hypercholesterolemia."

The results of his group's computer simulation study, he added, "indicate that avoiding these lipid changes may reduce patients' future risk of cardiovascular disease and thereby increase their overall life-expectancy."

Dr. Grover of the Montreal General Hospital and colleagues report in the March issue of the American Journal of Cardiology that they examined data from a randomized trial that compared lipid changes after 32 weeks of HAART including nelfinavir (Viracept) or atazanavir (Reyataz).

In patients who took nelfinavir, total cholesterol increased by 24% and LDL cholesterol rose by 28%. In atazanavir patients, the corresponding increases were 4% and 1%.

These results in combination with Framingham risk equations and other adjustments were used to estimate effects on life expectancy.

The researchers calculated that, over a 10-year period, regardless of the presence or absence of other coronary risk factors, the substantial increase in LDL cholesterol associated with nelfinavir therapy would raise the risk of coronary disease by about 50%.

"The absence of dyslipidemia was estimated to preserve life expectancy 0.15 to 1.53 additional years depending on a patient's age, gender, and other risk factors," the team reports.

Thus they conclude that "avoiding adverse lipid changes may be beneficial to many patients who have HIV."

03/16/05

Am J Cardiol 2005;95:586-591.

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