Antiretrovirals and Risk for Myocardial Infarction

The increased cardiovascular risks observed among HIV-infected patients are believed to stem partly from the infection and partly from specific antiretrovirals. To explore possible associations between HIV drugs and risk for myocardial infarction (MI), investigators conducted a case-control study using data from the French Hospital Database on HIV.

The study involved 289 HIV-infected patients who had a first definite or probable MI and 884 HIV-infected control patients (matched for age, sex, and clinical center) who had no history of MI. Conditional logistic regression models were used to adjust for potential confounders. The findings:

• Recent short-term use of abacavir was significantly associated with increased MI risk in the overall study population (odds ratio, 2.0). However, no association was seen in the subset of individuals who did not use cocaine or intravenous drugs (OR, 1.3).

• A post hoc analysis of all protease inhibitors (PIs), not including atazanavir and darunavir, indicated that cumulative exposure to any drug in this class, with the exception of saquinavir, was significantly associated with increased MI risk (OR per year of use, 1.2). Significant associations were seen for two individual PIs: amprenavir/fosamprenavir, with or without ritonavir boosting, and lopinavir/ritonavir (ORs per year of use, 1.5 and 1.3, respectively).

• No association was seen between nonnucleoside reverse transcriptase inhibitors and MI risk.

The researchers concluded that the relation between abacavir exposure and MI risk cannot be considered causal because it may be explained by confounding factors.