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Potent AIDS Drugs Tied to Heart Disease

European study contradicts earlier findings

WEDNESDAY, Nov. 19, 2003 (HealthDayNews) -- In a contradiction to earlier findings, new European research seems to confirm fears that powerful AIDS drugs put patients at higher risk for heart attacks and strokes.

However, researchers add that wherever the truth lies, there's no doubt the treatments are still worth taking.

"No matter what their side effects, these drugs are tremendously beneficial to AIDS patients in terms of prolonging their lives," says AIDS expert Dr. Henry Masur.

In the 1990s, researchers noticed young AIDS patients suffered from high cholesterol, increased levels of body fat and uncontrolled insulin levels. Their rates of heart disease also seemed to be higher than among healthy people.

The culprit has been elusive. "The question is why?" says Masur, chief of the critical care medicine department at the National Institutes of Health. "Is it because of HIV itself, or is it due to the drugs used to treat the virus? Or is it due to the fact that patients are living longer now, simply getting the events they would have gotten anyway? Or is it somehow related to a combination of the virus and the drugs?"

Earlier this year, American researchers announced they'd found no connection between HIV treatment and heart disease in 37,000 patients treated for HIV infection at Veterans Affairs medical centers.

In the new study, Danish researchers examined the 1999-2002 medical records of 23,468 HIV-positive patients. The findings appear in the Nov. 20 issue of the New England Journal of Medicine, along with a commentary from Masur.

The risk of heart attack rose the longer the patients were on the most powerful AIDS drug regimens, known as highly active antiretroviral therapy, "triple therapy," or the "AIDS cocktail." In total, the heart attack rate rose by 26 percent for each year the patients were on the treatment.

However, the number of patients who suffered heart attacks was small -- just 126. "The risk is low in absolute terms," says study co-author Dr. Jens D. Lundgren, director of the Copenhagen HIV Programme, who adds the study doesn't definitively confirm a link between AIDS drugs and heart disease.

Even so, Masur says there's little room for doubt. "It is likely it's the drugs are at fault."

It's not clear, however, how the drugs work to increase heart attack risk, although they do seem to boost cholesterol levels, potentially contributing to the clogging of arteries.

What's an AIDS patient to do?

Both Lundgren and Masur agree they need to watch their heart health, especially once they go on the most powerful drugs. "That means leading a healthy lifestyle in terms of exercise, diet and weight, and abstinence from tobacco," Masur says. The patients should watch their blood glucose levels, too, and take action if they appear to be developing diabetes, he says.

More information

Information about drug treatment for HIV infection is available from the U.S. Food and Drug Administration and the U.S. Centers for Disease Control and Prevention.

SOURCES: Henry Masur, M.D., chief, critical care medicine department, National Institutes of Health, Bethesda, Md.; Jens D. Lundgren, M.D., director, Copenhagen HIV Programme and associate professor, University of Copenhagen, Denmark; Nov. 20, 2003, New England Journal of Medicine
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