Protease inhibitor exposure and increased risk of cardiovascular disease in HIV‐infected patients

Abstract

Objectives To study the relationship between exposure to protease inhibitor (PI) therapy and increased risk of cardiovascular events in HIV‐infected patients. Methods We estimated the risk of cardiovascular disease (CVD) events with PI exposure in a cohort of HIV‐infected patients using a time‐dependent Cox proportional hazards model adjusting for the major CVD risk factors. Only the first CVD event for each subject was counted. Results Of a total of 7542 patients, 77% were exposed to PIs. CVD event rates were 9.8/1000 and 6.5/1000 person–years of follow‐up (PYFU) in the PI‐exposed and nonexposed groups, respectively (P=0.0008). PI exposure ≥60 days was associated with an increased risk of CVD event [adjusted hazards ratio (HR_adj) 1.71; 95% confidence interval (CI) 1.08–2.74; P=0.03]. Results from a subgroup of patients aged between 35 and 65 years were similar (HR_adj 1.90; 95% CI 1.13–3.20; P=0.02). Other significant risk factors included smoking status, age, hypertension, diabetes mellitus and pre‐existing CVD. Conclusions Patients exposed to PI therapy had an increased risk of CVD events. Clinicians should evaluate the risk of CVD when making treatment decisions for HIV‐infected patients.