Antiretroviral Drugs Have Lower Heart Attack, Stroke Risk, Than Previously Stated, Study Says
Antiretroviral drugs do not cause "premature" heart attack or stroke in HIV-positive patients, as previously believed, according to a study published in the Feb. 20 issue of the New England Journal of Medicine, the San Diego Union-Tribune reports. Dr. Samuel Bozzette of the San Diego Veterans Affairs Medical Center and colleagues from Johns Hopkins Bloomberg School of Public Health conducted a retrospective study of almost 37,000 patients who received care for HIV infection at Veterans Affairs facilities nationwide between January 1993 and June 2001. The researchers analyzed the type of antiretroviral drugs each patient had taken and for how long and whether the patients had any prior vascular disease. They found that about one-fourth of the patients previously had been treated for conditions associated with heart disease (Clark, San Diego Union-Tribune, 2/20). The researchers determined that between 1995 and 2001, when combination antiretroviral therapy became widely available, fewer HIV-positive patients were admitted for cardiovascular disease or stroke. Researchers also found "no relation" between the use of antiretroviral drugs -- including protease inhibitors, nucleoside analogues and non-nucleoside reverse transcriptase inhibitors -- and cardiovascular or stroke events. However, the researchers determined that the use of such drugs was associated with a "decreased hazard of death from any cause" (Bozzette et al., NEJM, 2/20). The researchers write, "Fear of accelerated vascular disease should not deter patients and providers from using the highest-quality care for HIV" (San Diego Union-Tribune, 2/20). They add, "This finding indicates that, even if cardiovascular and cerebrovascular complications were considered to be as bad as death, HIV-infected patients have been enormously better off since the advent of highly active antiretroviral therapy." In an accompanying "Perspective" piece, Dr. Daniel Kuritzkes of Harvard University and Boston-based Brigham and Women's Hospital calls for further research on the possible links between antiretroviral therapy and vascular events. Kuritzkes recommends extending the observation period from three or four years to 10 years to determine the long-term risks of HAART. He adds that patients taking these drugs should use "extra precautions to keep their blood vessels healthy," according to Reuters Health (McCook, Reuters Health, 2/19). Last week, researchers from Hvidovre University in Copenhagen, Denmark, released a study at the 10th Conference on Retroviruses and Opportunistic Infections that showed that some antiretrovirals increase the risk of heart attacks (Kaiser Daily HIV/AIDS Report, 2/14).This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.