- Home>
- Specialties>
- General Medicine>
- Summary and Comment
No Vascular Consequences from Antiretroviral Drugs ... Yet
Short-term use of antiretroviral therapies among HIV-positive men did not lead to an increase in adverse cardiac events.
Antiretroviral drugs save lives, but treatment is accompanied by substantial side effects. Among these are diabetes, lipid abnormalities, and changes in body morphology, which raise concerns that such drugs also might increase risk for cardiovascular and cerebrovascular disease. Some reports of premature vascular events in treated patients support this possibility.
Researchers scanned several large Veterans Affairs patient databases for patterns of cardiovascular and cerebrovascular disease among 36,766 HIV-positive patients who were treated from 1993 through 2001. Almost all patients were men, most were between 35 and 55 years old, 52% were black, and 24% had received treatment for vascular risk factors such as smoking, hypertension, or diabetes before beginning HIV therapy. Seventy percent of patients received antiretroviral drugs (mean treatment duration, 15 months).
The overall death rate declined markedly during the study. Rates of hospital admission for cardiovascular or cerebrovascular disease remained constant or declined. Patients with longer treatment histories were not more likely to be admitted for, or to die from, cardiovascular or cerebrovascular events. Overall, the cohort had lower rates of vascular disease than did an age- and sex-matched segment of the U.S. population.
Comment: The spectrum of metabolic abnormalities that is elicited by combination antiretroviral treatment bears an eerie resemblance to syndrome X, complete with insulin resistance and truncal obesity. These findings provide some reassurance that vascular disease does not develop rapidly, but longer observation periods clearly are necessary. In the meantime, patients who receive antiretrovirals also should receive standard treatments to reduce vascular risks.
— Abigail Zuger, MD
Published in Journal Watch General Medicine March 4, 2003
Citation(s):
Bozzette SA et al. Cardiovascular and cerebrovascular events in patients treated for human immunodeficiency virus infection. N Engl J Med 2003 Feb 20; 348:702-10.
- Medline abstract (Free)
Kuritzkes DR and Currier J. Cardiovascular risk factors and antiretroviral therapy. N Engl J Med 2003 Feb 20; 348:679-80.
- Medline abstract (Free)
Your Remark:
To ensure that your Reader Remark is not formatted as one long paragraph, precede new paragraphs with either a blank line or an indentation.