657   Impact of Treatment with Protease Inhibitor (PI) on Myocardial Infarction (MI) Occurrence in HIV-Infected Men.

M. Mary-Krause*¹, L. Cotte², M. Partisani³, A. Simon⁴, and D. Costagliola¹.
¹INSERM SC4, Paris;²Hotel Dieu, Lyon;³CHRU de Strasbourg; and⁴Pitié-Salpétrière, Paris, France.

Background:In the current context of dyslipidemia, hyperglycemia and lipodystrophia observed among HIV- seropositive subjects, it is important to study the course of coronary heart disease likely to be associated with this phenomenon.

Methods:The French Hospital Database on HIV was started in 1989 in 68 hospitals in France and concerns HIV-seropositive subjects followed in hospitals. The standardized data collection form includes characteristics of exposure group, values of usual biological markers, clinical manifestations, nature of treatments delivered, and death and cause of death as reported in the medical records. A follow-up form is used at each visit or hospital admission where a clinical manifestation is reported, a new treatment is prescribed or a change in biological markers appears, or at least every 6 months. Standardized morbidity ratios (SMR) were calculated with data from the French MONICA project as reference. Analyses were limited to subjects receiving PI to avoid, as much as possible, the impact of a notoriety bias.

Results:MI was diagnosed in 54 patients among 19795 men exposed to PI, corresponding to 36,907 persons- year (PY). Among these 54 subjects, 23 were diagnosed among subjects exposed less than 18 months to PI (group 1), 18 among subjects exposed between 18 and 29 months (group 2) and 13 among subjects exposed 30 months or more (group 3). The incidence rate of MI per 10,000 PY was estimated as 8.9+1.9 in group 1, 19.2+4.5 in group 2 and 34.7+9.6 in group 3. The expected incidence in the general population with same gender and same age was 10.8 cases per 10,000 PY. The SMR relative to the general population were 1.7 (95% CI = 1.0— 2.7) for group 2 and 3.1 (95% CI = 1.7—5.4) for group 3. With group 1 as reference, to control for background risk factors in HIV-infected men, the SMR were 2.0 (95% CI = 1.2—3.2) and 3.7 (95% CI = 2.0—6.3), respectively.

Conclusions:There was limited exposition to PI for more than 30 months, and a longer follow-up is therefore warranted. Nevertheless, our results indicate a dose-effect relationship, with a higher MI incidence rate among the cohort members exposed to PI for 18 months or more.