7th Conference - Abstract 35

Detection of Myocardial Ischemia in Protease Inhibitor (PI)-Treated HIV-Infected Patients with Hyperlipemia

C. LENORMAND-WALCKENAER, V. JOLY*, S. MATHERON, K. CHEMLAL, M. H. PREVOT, and D. LE GULUDEC. Hosp. Bichat-Claude Bernard, Paris, France

Coronary artery disease (CAD) and other vascular events have been described in PI treated HIV-infected patients (Pts). Stress thallium single photon emission computed tomography (SPECT) is the most sensitive and specific test to detect myocardial ischemia (MI). We prospectively assessed the incidence of MI by combined dipyridamole and exercise thallium imaging in HIV-infected Pts (> 18 yrs) treated for more than 12 months with PI and hyperlipemic (cholesterol > 6.7 mM and/or triglycerides > 3.5 mM). Each Pt underwent a physical examination, routine fasting cholesterol, LDL, HDL, triglycerides, glucose and a stress limited upright bicycle exercise. SPECT was considered positive if reversible or fixed defects involving > 2 segments were noted.
Twenty nine Pts (26 men and 3 women) were included (mean age 46.7±8.6 yrs, mean weight 72±12.2 kg). Mean exposure to PI therapy was 30.6±10 months. Baseline demographic values were 6.98±1.7 mM cholesterol, 0.86±0.3 mM HDL, 4.49±1.8 mM LDL, 4.69±2.4 mM triglycerides and 5.3±1.2 mM glucose. Other risk factors for CAD were smoking in 20 Pts and hypertension in 4 Pts. Mean CD4 cell count was 374 cells/mm³ and plasma viral load was below 200 cps/ml in 18/29 Pts. Only one Pt had abnormal ECG at rest with an inferior Q wave. During exercise testing (mean: 100 Watts), only 12 Pts were able to reach sufficient exercise (85% of predicted max heart rate). Two Pts had abnormal SPECT, one with a posterior fixed defect (posterior myocardial infarction) and one with a posterolateral reversible defect (3 segments). A history of typical chest pain was reported in these 2 Pts only. In conclusion, by using the most sensitive noninvasive method (SPECT), CAD was not detected in asymptomatic patients with hyperlipemia following a mean exposure of 30 months to PI therapy.

Key Words: hyperlipemia, myocardial ischemia, protease inhibitor