July 25, 2003 HIV-positive adults ages 18 to 34 may be more likely to suffer coronary heart disease than HIV-negative persons their age, a new UCLA study suggests. Reported in the August issue of the Journal of Acquired Immune Deficiency Syndromes, the findings emphasize the need for physicians to monitor HIV patients' cardiac health.
"Our study suggests that coronary heart disease may be accelerated in younger HIV-infected people," said Dr. Judith Currier, a researcher at the UCLA AIDS Institute and associate professor of infectious diseases at the David Geffen School of Medicine at UCLA. "It's important for physicians to incorporate heart-disease risk prevention into HIV primary care."
Currier and her associates reviewed six years of claims data from 28,513 HIV-positive Medi-Cal patients and 3,054,696 HIV-negative Medi-Cal patients. Both groups were 18 or older and had been free of heart disease for at least one year from Medi-Cal enrollment. The scientists did not include patients whose coronary heart-disease diagnosis preceded their HIV infection diagnosis.
After adjusting for available data on age, gender, antiretroviral therapy, hypertension and diabetes, Currier and her colleagues compared the rate and risk for coronary heart disease between the two populations. Then the researchers evaluated the relationship between the HIV patients' use of antiretroviral therapy and the number of first-time coronary heart-disease incidents in their group.
Currier's team uncovered a number of surprising results:
* The rate of coronary heart disease in HIV-infected men aged 18 to 34 and HIV-infected women aged 18 to 44 -- while very low -- was still statistically significantly higher than in HIV-negative people in those age groups. For example, the rate of coronary heart disease in 18- to 34-year-old HIV-positive men was 1.64 incidents per 100 patient years compared to 0.76 incidents per 100 patient years in HIV-negative men.
* In HIV-infected men under 34 and HIV-infected women under 45 on antiretroviral therapy, the rate of coronary heart disease was twice the rate of their HIV-positive counterparts who never took the drugs.
* There were no statistically significant links between antiretroviral therapy and HIV, or between HIV and coronary heart disease, in men over 34 and women over 44.
"Coronary heart disease is rare in younger people," said Currier, associate director of the UCLA Center for Clinical AIDS Research and Education. "Yet HIV infection appears to slightly elevate young adults' risk for heart disease when compared to HIV-negative persons their age."
The findings also suggest a slight association between antiretroviral therapy and increased coronary heart-disease risk in younger but not older HIV-infected patients, she said.
"The results of this study should not diminish clinicians' enthusiasm for antiretroviral therapy to treat their patients' HIV infection," Currier emphasized. "The benefits of antiretroviral therapy in slowing HIV progression and prolonging patients' lives outweigh its possible cardiac risks."
Currier pointed out that more studies are needed to investigate whether specific antiretroviral therapy agents contribute to coronary heart-disease risk.
"Our study was not able to examine the role of specific antiretroviral drugs and increased cardiac risk," she said. "Clearly, more research is needed in this area to draw firm conclusions."
Currier theorizes that HIV infection may have less influence on older patients' health, because other health conditions and lifestyle choices overshadow the virus' effect.
"As people with HIV live longer, their physicians need to address the other diseases that affect HIV-negative patients at their age," Currier said.
The Bristol-Myers Squibb Co. funded the study. Currier's co-authors included Dr. Anne Taylor, University of Minnesota School of Medicine; Felicity Boyd, Johns Hopkins University Bloomberg School of Public Health; and Christopher Dezii, Hugh Kawabata, Beth Burtcel, Jen-Fue Maa and Sally Hodder, Bristol-Myers Squibb Co.
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