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	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Sklar, P. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear Related Article PubMed Citation

ABSTRACT

Background It remains controversial whether exposure to combination antiretroviral treatment increases the risk of myocardial infarction.

Methods In this prospective observational study, we enrolled 23,468 patients from 11 previously established cohorts from December 1999 to April 2001 and collected follow-up data until February 2002. Data were collected on infection with the human immunodeficiency virus and on risk factors for and the incidence of myocardial infarction. Relative rates were calculated with Poisson regression models. Combination antiretroviral therapy was defined as any combination regimen of antiretroviral drugs that included a protease inhibitor or a nonnucleoside reverse transcriptase inhibitor.

Results Over a period of 36,199 person-years, 126 patients had a myocardial infarction. The incidence of myocardial infarction increased with longer exposure to combination antiretroviral therapy (adjusted relative rate per year of exposure, 1.26 [95 percent confidence interval, 1.12 to 1.41]; P<0.001). Other factors significantly associated with myocardial infarction were older age, current or former smoking, previous cardiovascular disease, and male sex, but not a family history of coronary heart disease. A higher total serum cholesterol level, a higher triglyceride level, and the presence of diabetes were also associated with an increased incidence of myocardial infarction.

Conclusions Combination antiretroviral therapy was independently associated with a 26 percent relative increase in the rate of myocardial infarction per year of exposure during the first four to six years of use. However, the absolute risk of myocardial infarction was low and must be balanced against the marked benefits from antiretroviral treatment.

Source Information

Address reprint requests to Dr. Jens D. Lundgren, DAD Coordinating Center, Copenhagen HIV Program, Section 044, Hvidovre University Hospital, 2650 Copenhagen, Denmark, or at jdl{at}cphiv.dk (Dr. Lundgren).

Full Text of this Article

Related Letters:

Trends in Rates of Myocardial Infarction among Patients with HIV
Holmberg S. D., Moorman A. C., Greenberg A. E., Friis-Møller N., Sabin C., Lundgren J. D., the DAD Steering Committee
Extract | Full Text | PDF  
N Engl J Med 2004; 350:730-732, Feb 12, 2004. Correspondence

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