Increased Morbidity from Severe Coronary Heart Disease in HIV-Patients Receiving Protease Inhibitors.
A. JUETTE*, B. SALZBERGER, C. FRANZEN, K. ROEMER, V. DIEHL, G. FAETKENHEUER. Dept. of Med. I, Univ. Hosp., Cologne, Germany.
Introduction: Myocardial infarction and other vascular events have been reported to occur in association with protease inhibitor (PI) therapy. Changes in the incidence of severe coronary heart disease after the introduction of PI's have not been studied yet. We examined the incidence of myocardial infarction in two large unselected cohorts of HIV-patients with and without protease inhibitor treatment.
Methods: Analysis of a prospective cohort of HIV-patients attending our clinic between 01.01.90 and 31.08.98. Patients not receiving PI's were included in cohort I, patients treated with PI's between 01.01.95 and 31.08.98 in cohort II. Event rates were calculated as events per 100 patient-years. The Chi-Square-Test was used for statistical analysis.
Results: 951 patients were included in cohort I, 373 in cohort II. Observation period was 526.527 days in cohort I and 171.383 days in cohort II. Three cases of myocardial infarction were observed in cohort I, five cases in cohort II. The eventrates for myocardial infarction were 0,21 (0,06-0,54 95%CI) for cohort I and 1,06 (0,42-2,24 95%CI) for cohort II (p=0,08). Myocardial infarctions occurred under different PI-regiments (duration of therapy 3 to 17 months). None of these patients (5 males, median age 50 years) had a history of coronary heart disease, but all had at least two coronary risk factors including smoking and hypercholesterinemia. Severe hypercholesterinemia developed under PI-treatment in four of five cases.
Conclusion: The incidence of myocardial infarction in protease inhibitor treated patients was higher than in untreated patients, although not statistically significant. This might be associated with the development of severe hypercholesterinemia under protease inhibitor therapy. The pathophysiology of this phenomenon and the contribution of other possible risk factors has to be studied yet.
Key Words: Protease - Inhibitor, Long-term side effects, Coronary heart disease