Background: CHD events have been reported after administration of PI to HIV-infected patients. Our objective was to compare the distribution of CHD risk factors and estimates of CHD risk in French HIV+ men under PI and a sample of the general population.

Methods: 223 HIV+ men aged 35-44 years, from the French APROCO cohort, 12/20 months after initiation of PI, compared to 527 men, same age, from a sample of the general population, the French WHO-MONICA project. All comparisons were adjusted for body mass index (BMI) because it was lower in HIV men: patients with BMI<20 kg/m², 20-24 and ³25 were: 13%, 70%, and 17% (APROCO) vs 4%, 44%, and 52% (MONICA) (p<10^-6).

Results: In HIV men, prevalence of hypertension was lower (5 vs 13%, p=0.003), whereas prevalence of smoking was higher (57 vs 33%, p<10^-4). Mean total and LDL-cholesterolemia were not different in the 2 groups (2.22 vs 2.24 g/L and 1.42 vs 1.50 g/L, respectively), although, in HIV men, mean HDL-cholesterolemia was lower (0.44 vs 0.50 g/L, p<10^-4), and mean triglyceridemia was higher (1.90 vs 1.27 g/L, p<10^-4). Prevalence of diabetes was not different in the 2 groups (2 vs 3%). The estimate of the CHD risk (based on the French PRIME Cohort model) was increased in HIV men: RR=1.20 (p<10^-6).

Conclusions: In HIV men started on PI-containing regimen, the estimation at M12-M20 of an increased CHD risk has important implications: long-term follow-up to determine if the observed CHD risk increases over time is mandatory; regular assessment of CHD risk factors should be included in the management of these patients, at initiation of HAART and thereafter; interventions to reduce potential modifiable risk factors should be considered: reduction of smoking, diet. The benefit of drugs acting on lipid metabolism could be studied in clinical trials.