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Session 102 Poster Abstracts
Cardiovascular Complications: Risk Factors, Incidence, Prevalence, and Outcomes
Tuesday, 1:30 - 3:30 pm
Poster Hall


736    
Protease Inhibitor Exposure Time and Risk of Cardiovascular Disease in HIV-infected Patients
U Iloeje*1, Y Yuan2, G L'Italien1, J Mauskopf3, S Holmberg4, A Moorman4, K Wood5, and R Moore6
1Bristol-Myers Squibb Co., Wallingford, CT, USA; 2Bristol-Myers Squibb Co., Plainsboro, NJ, USA; 3Res. Triangle Inst., Research Triangle Park, NC, USA; 4CDC, Atlanta, GA, USA; 5Cerner Corp., Kansas City, MO, USA; and 6Johns Hopkins Med. Inst., Baltimore, MD, USA

Background:  Some PI are associated with hyperlipidemia, insulin resistance, hypertension, and diabetes mellitus, which in turn are risk factors for cardiovascular disease. Our objective was to quantify the effect of PI exposure time on subsequent cardiovascular disease events.

 

 

Method:  The study population was derived from the HIV Insight database with data collection from HIV clinics by Cerner and the HIV Outpatient Study. Patients (age >18) from January 1, 1996, to June 30, 2003, were eligible. Patients were followed to the first cardiovascular disease event (myocardial infarction, angina, coronary artery disease, PTCA/CABG, stroke, TIA, PVD) or censored at end of follow-up. Co-variates included age, gender, race, weight, hyperlipidemia, cardiovascular disease, diabetes mellitus, hypertension, smoking, intravenous drug use, and cocaine use. Exposure time was specified as cumulative PI exposure days, calculated at each cardiovascular disease event or censoring. Time-dependent Cox proportional hazards regression was used to estimate the adjusted hazards ratio (HRadj) of time to the first cardiovascular disease event.

 

 

Result:  Among 7542 patients, PI use was reported in 77% and 127 (1.7%) had at least one cardiovascular disease event. Baseline demographic distributions were as follows: 86% male; 58% white; 27% African American; mean age, 39 years; mean weight, 169 lb. For the PI and non-PI groups, cardiovascular disease events per 1000 patient-years were:  9.8 and 6.5, respectively, overall; and 11.5 and 7.9 in a subset aged 35 to 65 years. For PI exposure >60 days, HRadj (95%CI) for cardiovascular disease was 1.7 (1.07 to 2.74, p = 0.03) overall and 1.9 (1.13 to 3.2, p = 0.02) in the 35 to 65 subset. In a model defining PI exposure as 1 to 180; 181 to 365; >365 the HRadj (95%CI) for cardiovascular disease  were 1.03 ( 0.70 to 1.53); 1.13 (0.75 to 1.70); 1.51 (0.98 to 2.32, p = 0.06) overall, and 0.91 (0.59 to 1.4); 1.05 (0.67 to 1.64); 1.63 (1.01 to 2.63, p = 0.05), in the 35 to 65 subset.

Conclusions:  PI exposure was found to increase cardiovascular disease risk in this study. Cardiovascular disease risk was also shown to increase with cumulative PI exposure.  Further long-term follow-up data will be needed to confirm these findings. Evaluating HIV-infected patients for cardiovascular disease risk factors may be important in selecting HAART regimens.

Keywords: Cardiovascular Diseases; Protease Inhibitor Therapy; Treatment Complications