Protease inhibitors and cardiovascular outcomes in patients with HIV-1

HOPS is an ongoing prospective observational cohort in which patients have been continuously recruited and followed up since 1992.

Nine clinics in eight cities (Atlanta; Chicago; Denver;Oakland; Philadelphia; Stony Brook, NY; Tampa, Fla.; and Washington DC) serve as study sites. HOPS assessed 5,672 HIV-1-infected patients with a mean age of 42.6 for incidence of myocardial infarction. Eighty-two percent of the participants were men; 38% were nonwhite; 63% were homosexual; 12% were injection drug users; 19% were heterosexual; and 12% had other or unspecified risk factors. Of the patients, 3,247 took protease inhibitors after their 1996 introduction; 2,425 did not.

During the observation period, 21 persons had a myocardial infarction. Nineteen of them were among the 3,247 patients taking protease inhibitors. Two were among the 2,425 patients who did not take the drugs. Researchers also documented 15 instances of angina, 11 among the 3,247 who took protease inhibitors, four among the other group. Data showed no single protease inhibitor to be significantly more likely than the others to be associated with the incidence of myocardial infarction.

The study results “suggest that myocardial infarctions and perhaps angina could arise in patients taking protease inhibitors. The overall frequency of myocardial infarctions rose greatly after protease inhibitors were introduced, and the incidence in HOPS patients rose after protease inhibitors had been used for a few years,” according to the report.

The authors noted that most patients who had a myocardial infarction or an angina episode also had other traditional risk factors, such as smoking, hypertension, hyperlipidemia (a high concentration of lipids in the blood), and insulin resistance associated with diabetes mellitus. They suggested that doctors treating HIV-1 patients with protease inhibitors be aware of the possibly increased cardiovascular disease risk and intervene to stop smoking and to diagnose and treat the other risk factors.

Myocardial infarction is still infrequent, usually occurs in people with other risk factors for cardiovascular disease, and should not detract from the appropriate use of these drugs for patients with HIV-1, they wrote.

Scott D. Holmberg; Anne C. Moorman; John M. Williamson et al and the HIV Outpatient Study (HOPS) Investigators. Lancet (11.30.02) Vol. 360: P. 1747-1748