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MI Incidence Stable in Patients on HIV Antiretrovirals

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MI Incidence Stable in Patients on HIV Antiretrovirals

Reuters Health Information 2008. © 2008 Reuters Ltd.

Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

NEW YORK (Reuters Health) Apr 23 - Although the cardiovascular risk profile has worsened in recent years for many patients on long-term combination antiretroviral therapy for HIV infection, there has not been a corresponding increase in myocardial infarctions and other cardiovascular events, researchers report in the April 1st issue of Clinical Infectious Diseases.

"We have seen a gradual worsening in their cardiovascular risk," Dr. Caroline A. Sabin told Reuters Health, "with increased numbers of patients now having diabetes, high blood pressure and raised lipid levels. This is partly to do with the fact that these individuals have aged, but also may be a direct consequence of some antiretroviral drugs."

Dr. Sabin of Royal Free and University College Medical School, London, and colleagues studied data on more than 33,000 HIV patients from a number of cohorts who were followed from late 1999 to early 2006.

The proportion of patients at high risk of cardiovascular disease rose from 40.1% between 1999 and 2000 to 47.8% between 2005 and 2006. Among related factors were increasing age, hypertension and diabetes.

Of almost 29,000 patients who were known not to be not using lipid-lowering drugs at the start of the study, 9.7% went on to do so during follow-up.

By the February 1, 2006 study end, there were 445 episodes of myocardial infarction. The overall event rate was 0.32 per 100 patient-years of follow-up.

This event rate remained fairly constant. It was 0.32 from 1999 to 2000, reached a peak of 0.43 in 2001, and between 2005 and 2006, had fallen to 0.22.

Thus, despite greater risks, continued Dr. Sabin, "the MI rate has not increased at the rate that we might expect. We believe this is a result of the targeted use of interventions -- particularly lipid-lowering drugs -- in some patients."

"However," she concluded, "despite these positive findings, other research from the same study suggests that many high-risk patients may still not be receiving optimal therapy to prevent heart disease."

Clin Infect Dis 2008;46:1101-1110.

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