An Unexpected Effect of Atazanavir on Carotid Wall Thickness

HIV-infected patients are at increased risk for cardiovascular disease (CVD). Some antiretroviral agents have been associated with CVD in observational studies, but randomized, prospective data are lacking. Now, investigators have analyzed changes in carotid intima-media thickness (IMT), a marker for future CVD, in a subset of participants in ACTG A5257. This randomized trial compared ritonavir-boosted atazanavir, ritonavir-boosted darunavir, and raltegravir, each combined with tenofovir/FTC, for initial HIV therapy (NEJM JW Infect Dis Dec 2014 and Ann Intern Med 2014; 161:461).

A total of 328 participants underwent carotid artery ultrasonography before starting antiretroviral therapy and then at weeks 48, 96, and 112 to 144. More than 85% m…