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Previous Volume 348:702-710 February 20, 2003 Number 8 Next

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ABSTRACT

Background Metabolic abnormalities associated with human immunodeficiency virus (HIV) infection, including dysglycemia and hyperlipidemia, are increasingly prevalent, and there is concern about the possibility of an association with accelerated cardiovascular and cerebrovascular disease.

Methods We conducted a retrospective study of the risk of cardiovascular and cerebrovascular disease among the 36,766 patients who received care for HIV infection at Veterans Affairs facilities between January 1993 and June 2001.

Results For antiretroviral therapy, 70.2 percent of the patients received nucleoside analogues, 41.6 percent received protease inhibitors, and 25.6 percent received nonnucleoside reverse-transcriptase inhibitors for a median of 17 months, 16 months, and 9 months, respectively. Approximately 1000 patients received combination therapy with a protease inhibitor for at least 48 months, and approximately 1000 patients received combination therapy with a nonnucleoside reverse-transcriptase inhibitor for at least 24 months. Between 1995 and 2001, the rate of admissions for cardiovascular or cerebrovascular disease decreased from 1.7 to 0.9 per 100 patient-years, and the rate of death from any cause decreased from 21.3 to 5.0 deaths per 100 patient-years. Patient-level regression analyses indicated that there was no relation between the use of nucleoside analogues, protease inhibitors, or nonnucleoside reverse-transcriptase inhibitors and the hazard of cardiovascular or cerebrovascular events, but the use of antiretroviral drugs was associated with a decreased hazard of death from any cause.

Conclusions Use of newer therapies for HIV was associated with a large benefit in terms of mortality that was not diminished by any increase in the rate of cardiovascular or cerebrovascular events or related mortality. Fear of accelerated vascular disease need not compromise antiretroviral therapy over the short term. However, prolonged survival among HIVinfected patients means that longer-term observation and analysis are required.

Source Information

From the Veterans Affairs Quality Enhancement Research Initiative for HIV and the Center for Research in Patient Oriented Care at the Veterans Affairs San Diego Health Care System, San Diego (S.A.B., C.F.A., H.K.T.); the University of California, San Diego, La Jolla (S.A.B., H.K.T.); RAND Health, Santa Monica, Calif. (S.A.B.); the Veterans Affairs Center for Quality Management in Public Health, Palo Alto, Calif. (S.W.C.); and the Johns Hopkins Bloomberg School of Public Health, Baltimore (T.A.L.).

Address reprint requests to Dr. Bozzette at the Department of Medicine, San Diego Veterans Affairs Medical Center, 3350 La Jolla Village Dr., San Diego, CA 92161, or at sbozzette{at}ucsd.edu.

Full Text of this Article

Related Letters:

Cardiovascular Disease and HIV Infection
Klein D., Hurley L. B., Sidney S., Bozzette S. A., Louis T. A.
Extract | Full Text | PDF  
N Engl J Med 2003; 349:1869-1870, Nov 6, 2003. Correspondence

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