Background:  Coronary heart disease (CHD) continues to be a concern in the long-term care of HIV⁺ patients. As patients age and new ART become available, ongoing monitoring of event rates, practice patterns, and risk profiles is warranted.

Methods:  We continue to monitor CHD and myocardial infarction (MI) events among HIV⁺ male members of Kaiser Permanente Northern California, and among age-similar HIV^­ male members. Ongoing observational follow-up now extends through June 30, 2005. Age-adjusted CHD/MI rates were calculated for HIV⁺ and HIV^­ patients overall, and by protease inhibitor (PI) exposure among HIV⁺ patients. Changes over time in use of ART (↓ stavudine [d4T] and ↑ atazanavir [ATV]), use of lipid-lowering therapy, blood pressure control, and smoking were examined. Framingham 10-year CHD risk score formulas were used to estimate mean component scores and 10-year CHD risk for 2000-2001 and 2004-2005.

Results:  In 9.5 years of observation, 5430 HIV⁺ people had 140 CHD events (86 MI) in 11,390 person-years of non-PI follow-up (all time before PI start, or never PI) and 15,527 person-years of PI follow-up (all time after PI start, median 4.3 years). We analyzed 307,000 person-years of HIV^­ follow-up. Age-adjusted CHD/MI rates for HIV⁺ patients exceeded those of HIV^­ (CHD, 6.0 vs 2.9 events/1000 person-years, p <0.0001; MI, 3.6 vs 2.2, p = .002). Rates for pre- and post-PI exposure continue to suggest ↑ risk with PI exposure (CHD, 4.8 vs 6.9, p = 0.09; MI, 3.0 vs 4.2, p = 0.20). Age-adjusted relative risk (RR) for MI in 4 PI exposure duration periods was 1.0 for any exposure <2 years (ref), 1.5 for 2 to 3.9 years, 1.8 for 4 to 5.9 years, and 1.4 for >6 years. Overall MI RR = 1.16 per year of PI exposure (95%CI 1.0, 1.4; p = 0.11). Percentage of ART-treated patients on d4T ↓ from 49% in 2001Q3 to 13% in 2005Q3 (p <0.0001); percentage of PI-treated patients on ATV ↑ from 0% in 2003Q2 to 33% in 2005Q3 (p <0.0001); percentage of PI-treated patients on lipid-lowering therapy ↑ from 1% in 1997Q4 to 27% in 2005Q3 (p <0.0001). Mean cholesterol, HDL, and systolic blood pressure components of Framingham risk scores each improved from 2000-2001 to 2004-2005 (p <0.0001). Percentage of current smokers varied from 17% to 21% to 18% in 2000-2005. Mean Framingham risk scores were reduced from 8.6% in 2000-2001 to 8.4% in 2004-2005, despite a significant ↑ in the mean age score component of FRS (p <0.0001).

Conclusions:  CHD/MI rates are higher among HIV⁺ men than HIV^­ men and appear highest in PI-exposed patients. The apparent initial ↑ in MI RR with ↑ PI exposure appears interrupted after 6 years. Over the period studied, 10-year CHD risk appears stable, despite an aging cohort. These observations are consistent with the observed changes in ART prescribing patterns.