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Previous Volume 356:1723-1735 April 26, 2007 Number 17 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Perspective by Hughes, M. D. Editorial by Stein, J. H. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background We have previously demonstrated an association between combination antiretroviral therapy and the risk of myocardial infarction. It is not clear whether this association differs according to the class of antiretroviral drugs. We conducted a study to investigate the association of cumulative exposure to protease inhibitors and nonnucleoside reverse-transcriptase inhibitors with the risk of myocardial infarction.

Methods We analyzed data collected through February 2005 from our prospective observational study of 23,437 patients infected with the human immunodeficiency virus. The incidence rates of myocardial infarction during the follow-up period were calculated, and the associations between myocardial infarction and exposure to protease inhibitors or nonnucleoside reverse-transcriptase inhibitors were determined.

Results Three hundred forty-five patients had a myocardial infarction during 94,469 person-years of observation. The incidence of myocardial infarction increased from 1.53 per 1000 person-years in those not exposed to protease inhibitors to 6.01 per 1000 person-years in those exposed to protease inhibitors for more than 6 years. After adjustment for exposure to the other drug class and established cardiovascular risk factors (excluding lipid levels), the relative rate of myocardial infarction per year of protease-inhibitor exposure was 1.16 (95% confidence interval [CI], 1.10 to 1.23), whereas the relative rate per year of exposure to nonnucleoside reverse-transcriptase inhibitors was 1.05 (95% CI, 0.98 to 1.13). Adjustment for serum lipid levels further reduced the effect of exposure to each drug class to 1.10 (95% CI, 1.04 to 1.18) and 1.00 (95% CI, 0.93 to 1.09), respectively.

Conclusions Increased exposure to protease inhibitors is associated with an increased risk of myocardial infarction, which is partly explained by dyslipidemia. We found no evidence of such an association for nonnucleoside reverse-transcriptase inhibitors; however, the number of person-years of observation for exposure to this class of drug was less than that for exposure to protease inhibitors.

Source Information

The members of the writing committee (Nina Friis-Møller, M.D., Ph.D., University of Copenhagen, Copenhagen; Peter Reiss, M.D., Ph.D., Academic Medical Center, Amsterdam; Caroline A. Sabin, Ph.D., Royal Free and University College, London; Rainer Weber, M.D., University Hospital Zurich, Zurich, Switzerland; Antonella d'Arminio Monforte, M.D., D.M.Sc., University of Milan, Milan; Wafaa El-Sadr, M.D., M.P.H., Columbia University, Harlem Hospital, New York; Rodolphe Thiébaut, M.D., Ph.D., INSERM E0338 and U593, Victor Segalen–Bordeaux 2 University, Bordeaux, France; Stephane De Wit, M.D., Ph.D., Centre Hospitalier Universitaire Saint-Pierre, Brussels; Ole Kirk, M.D., D.M.Sc., University of Copenhagen, Copenhagen; Eric Fontas, M.D., Centre Hospitalier Universitaire, Nice, Hôpital de l'Archet, Nice, France; Matthew G. Law, Ph.D., National Centre in HIV Epidemiology and Clinical Research, Sydney; Andrew Phillips, Ph.D., Royal Free and University College, London; and Jens D. Lundgren, M.D., D.M.Sc., University of Copenhagen, Copenhagen) of the DAD Study Group assume responsibility for the overall content and integrity of the article.

Address reprint requests to Dr. Lundgren at the Copenhagen HIV Program, Faculty of Health Sciences, University of Copenhagen, Panum Institute, Blegdamsvej 3, 2200 Copenhagen N, Denmark, or at jdl{at}cphiv.dk.

Full Text of this Article

Related Letters:

Antiretroviral Drugs and the Risk of Myocardial Infarction
Kaplan R. C., Tien P. C., Lazar J., Zangerle R., Sarcletti M., Pollack T. M., Rind D. M., Sabin C., Friis-Møller N., Lundgren J. D., the Writing Committee of the DAD Study Group , Stein J. H.
Extract | Full Text | PDF  
N Engl J Med 2007; 357:715-717, Aug 16, 2007. Correspondence

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