Exposure to protease inhibitors increases MI risk for HIV-infected patients
MedWire News: Patients infected with human immunodeficiency virus (HIV) treated with all protease inhibitors (PIs) except saquinavir have a significantly increased risk for myocardial infarction (MI).
However, exposure to nucleoside reverse transcriptase inhibitors (NRTIs), particularly abacavir, or non-NRTIs was not linked to increased risk for MI in these patients.
To investigate previously suggested links between HIV medication and risk for MI, Dominique Costagliola (INSERM, Paris, France) and colleagues carried out a study of 289 HIV-infected patients, aged a median of 47 years, who experienced MI between 2000 and 2006. They also recruited 884 age-, gender-, and clinical-center-matched controls with HIV, but no history of MI.
As reported in the Archives of Internal Medicine, cumulative exposure to all PIs except for saquinavir was associated with significantly increased risk for MI, with an odds ratio (OR) of 1.15. After accounting for confounders, the increased risk was significant for amprenavir/fosamprenavir with or without ritonavir and lopinavir with ritonavir with ORs of 1.53 and 1.33, respectively, but not for indinavir, nelfinavir, or saquinavir with or without ritonavir.
Patients who took the NRTI zidovudine had a borderline significant increased risk for MI (OR=1.09), but no significant associations were observed for other NRTIs and the cumulative risk for the drug class was nonsignificant.
In addition, no significant increased risk for MI was associated with exposure to non-NRTI drugs.
"Cumulative exposure to PIs has been associated with risk of MI in HIV-infected patients, but the risk associated with individual PIs has not been widely reported, to our knowledge," write the authors.
"More recently, specific nucleoside reverse transcriptase inhibitors (NRTIs), particularly abacavir, were incriminated."
The results of this study, however, suggest that although cumulative exposure to PIs does seem to increase the risk for MI in HIV patients, exposure to abcavir and other NRTIs and non-NRTIs does not, they conclude.
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By Helen Albert