While it is possible there is a long-term risk, it is "overwhelmed" by the benefits of drug treatment, says study author Dr. Samuel A. Bozzette, director of health research at the San Diego Veterans Affairs Medical Center. The results appear in the Feb. 20 issue of The New England Journal of Medicine.
"If you look at the total risk of death or heart attack, people will still be enormously better off with treatment," Bozzette says. Without treatment, patients develop AIDS and die.
The fears have been aroused because the antiretroviral drugs given to HIV-infected people raise blood levels of cholesterol, increase resistance to insulin and increase body fat, all risk factors associated with cardiovascular disease, the journal report says. So Bozzette and his colleagues did a study of the nearly 37,000 patients treated for HIV infection at Veterans Affairs health-care centers between 1993 and 2001.
They found a major drop -- 75 percent -- in overall mortality, because the people were not dying of AIDS. However, they also found the incidence of heart attacks and stroke and deaths caused by them stayed level, or even decreased slightly. There was no increased risk of cardiovascular events associated with any of the multitude of drugs given to treat HIV infection, the report says.
"Is it possible that there will be some increase in risk?" Bozzette asks. "Yes, because the metabolic effects that produce the risk are real. But this study shows that the benefits of therapy utterly overwhelm any possible increase in risk."
It's even possible the antiretroviral drugs might protect the arteries, Bozzette adds. "HIV is directly toxic to the blood vessels, so treating HIV reduces blood vessel injury," he says.
The story is far from over, because the people in the study were treated for a relatively short time and cardiovascular risk "plays out over the course of decades," says Dr. Daniel R. Kuritzkes, director of AIDS research at Brigham and Women's Hospital in Boston and co-author of an accompanying editorial.
Just last week, a Scandinavian speaker at an international meeting in Boston described a study that reported a 26 percent increase in cardiovascular events in HIV-infected persons treated for longer periods at 11 centers in the Europe -- an increase that appears to increase with the length of treatment, Kuritzkes says.
"Even that risk is small enough so that it is far outweighed by the benefits of treatment," he says.
However, it is something that physicians have to keep in mind, Kuritzkes says, because drug treatment has been so effective.
"Because patients are living so much longer, we need to be attuned to the long-term risks and accept therapies that minimize those risks," he says.