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Do Protease Inhibitors Increase the Risk for Coronary Heart Disease among HIV-Positive Patients? Additional Follow-Up D. KLEIN*1, L. HURLEY2, and S. SIDNEY2.
1Kaiser Permanente Med. Care Program, Hayward, CA; and 2Kaiser Fndn. Res. Inst., Oakland, CA Background: Concern has been raised over increased risk of coronary heart disease (CHD) in patients receiving protease inhibitor (PI) therapy, perhaps consequent to higher lipid levels in patients on PIs and/or a direct thrombogenic effect of these drugs.
Methods: Kaiser Permanente Northern California (KPNC), a not-for-profit HMO, cares for 2.8 million members. HIV positive (+) Health Plan (HP) members were followed in the period 1/1/96 to 6/30/99 and hospital events for CHD (ICD9 codes 410-414, primary discharge diagnosis) among the HIV+ cohort were identified. Patients with CHD events prior to the start of follow-up were excluded. Follow-up started 1/1/96 or at HIV diagnosis (whichever came later) and continued through the earliest of HP termination, death, or end of observation (6/30/99). Person-time was assigned to two categories: non-PI follow-up - days of follow-up which preceded any PI use; or PI follow-up - days of follow-up following the first use of a PI, if any. Patients could contribute time to both non-PI and PI follow-up. Age-adjusted (1990 census) incidence rates and confidence intervals (CI) were calculated overall and separately for non-PI and PI follow-up. CHD risk factors were assessed among members with events.
Results: Overall, 4526 HIV patients contributed a mean of 2.6 person-years of follow-up and experienced 42 CHD events, representing an increase of 2500 person-years and 15 new events over what has been previously reported. 4518 patients contributed a mean of 1.4 person-years of non-PI follow-up and had 20 CHD events. 2661 patients contributed a mean of 2.0 person-years of PI follow-up and had 22 CHD events. Age-adjusted CHD hospitalization rates per 1000 person-years and 95% CIs were 5.6 (3.5, 7.6) overall, 5.5 (2.5, 8.4) for non-PI follow-up and 5.7 (2.8, 8.5) for PI follow-up. Multiple risk factors for CHD were present in our patients: hypertension (59%), hypercholesteremia (54%), diabetes mellitus (15%) and current smoker (41%).
Conclusion: In our ongoing study, our data continue to suggest that PI use does not increase short-term risk for CHD. As in all patients with multiple risk factors for CHD, risk reduction management is warranted.
Key Words: CHD, Epidemiology, HIV
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