AIDS: Long-term HIV treatment may reduce risk of atherosclerosis

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Antiretroviral drugs for HIV do not increase the risk for coronary atherosclerosis, furthering the suggestion that antiretroviral therapy may offer men with HIV some protection against atherosclerosis, according to a study published in the Aug. 8 issue of AIDS.

The study, part of the Multicenter AIDS Cohort Study (MACS) initiated in 1983, measured levels of coronary artery calcification (CAC) in nearly 950 HIV-positive and HIV-negative men by CT scanning completed between 2004 and 2006.

Controlling for traditional atherosclerosis risk factors such as age, family history, smoking and blood pressure, the researchers found that CAC scores were almost 60 percent lower in HIV-positive men who received a combination of three or more highly active antiretroviral therapy (HAART) for more than eight years compared to HIV-negative men.

According to investigators, HAART has been associated with an increase in cholesterol and other factors associated with atherosclerosis, leading some to question whether long-term use increases the risk of heart attack.

“While some studies have found an association between these antiretroviral treatments and increased risk of cardiovascular disease, we believe our findings should reassure clinicians that using antiretroviral therapy over time does not appear to put patients at greater risk for coronary atherosclerosis and may, in fact, be more beneficial than we had initially thought,” said lead author Lawrence Kingsley, PhD, associate professor of the departments of infectious diseases, microbiology and epidemiology at the University of Pittsburgh Graduate School of Public Health.

The researchers also found that for both HIV-positive and HIV-negative men, older age was most strongly associated with the presence of coronary atherosclerosis. Smoking, lipid abnormalities and family history also played a role.

“This was not surprising since these are the major risk factors for atherosclerosis in the general population," Kingsley said. "The purpose of our study, however, was to investigate whether long-term HAART usage was a major risk factor.”

“These results could be due, in part, to lower lipid values of HIV infected men prior to beginning antiretroviral therapy and high use of lipid-lowering drugs. The key is that controlling risk factors for atherosclerosis should be a priority," added study co-author Lewis Kuller, MD, DrPH, professor of epidemiology at the University of Pittsburgh Graduate School of Public Health.

“What remains to be determined is whether use of the newest antiretroviral therapies confers an even better outcome and whether lipid-lowering therapies will further improve cardiovascular risk in the HIV-infected population. Our future research will address these questions,” Kingsley concluded.