Background:  Abnormalities of lipid metabolism that have emerged with the use of more aggressive antiretroviral therapy (ARV) raise concerns about a possible effect on cardiovascular-cerebrovascular (CV-CV) morbidity and mortality. We evaluated trends in ARV and CV-CV outcomes in all persons treated for HIV in US Veterans Health Administration facilities between January 1993 and June 2001.

Methods:  We analyzed 8.5 years of data from the Immunology Case Registry of the VA AIDS Service, and other VA databases; and 7 years of data from the national death index. We tracked ARV use, hospital admissions (HA) for CV-CV, and all-cause mortality through June 2001, and death due to CV-CV through December 1999.

Results: Between January 1993 and June 2001, the VA provided >1.4 million ARV prescriptions to 36,766 HIV+ patients seen for a mean of 40 months, yielding 121,936 patient-years of follow-up. There were 1764 CV-CV attributable HA, 521 CV-CV attributable deaths (through December 1999 only), & 16,731 deaths overall.

 

Years of exposure/100 patient-years	1993	1995	1997	1999	2001
Any antiretroviral	23.1	23.1	56.1	57.9	60.1
Nucleoside analog RTI	23.1	23.1	53.9	54.1	56.0
Protease Inhibitor	---	---	33.0	40.1	35.9
Non-nucleoside RTI	---	---	2.9	16.5	22.9
Events/100 patient-years
CV-CV attributable admit	1.6	1.7	1.3	1.3	0.9
CV-CV attributable admit or death	2.0	2.2	1.8	1.8	--–
All cause mortality	18.0	21.3	9.3	6.9	5.0

 

Conclusions:  Large increases in ARV use among large numbers of VA patients since the adoption of HAART were accompanied by slight declines in CV-CV events and sharp declines in overall mortality. These findings do not support a hypothesis of association between NRI, PI, or NNRTI exposure and excess CV-CV morbidity and mortality in a population over several years of treatment.