HIV Drugs May Raise Heart Attack Risk

But the danger from protease inhibitors remains small, experts say.

By E.J. Mundell
HealthDay Reporter
Wednesday, April 25, 2007; 12:00 AM

Copyright © 2007 ScoutNews, LLC. All rights reserved.

WEDNESDAY, April 25 (HealthDay News) -- Drugs that many HIV-infected patients use to keep AIDS at bay may also raise their risk for heart attack over time, a new study finds.

However, experts stressed that the danger is minimal compared to the life-extending effects of these medications, called protease inhibitors.

"So far, the benefits of treatment clearly outweigh any possible adverse effects," said lead researcher Dr. Jens Lundgren, head of the Copenhagen HIV Program at Hvidovre University Hospital in Denmark. "But perhaps longer exposure in an aging population may show that adverse effects may be a major problem over decades of therapy."

The findings, published in the April 26 issue of the New England Journal of Medicine, come on the heels of a related study published Tuesday in the Journal of Clinical Endocrinology and Metabolism. That research, by a team at Harvard Medical School, found that HIV infection -- and possibly, treatment -- boosted rates for heart attack nearly twofold.

It has been tough for scientists to pinpoint the source for the excess cardiovascular risk noted in HIV patients, however.

Experts first noticed a hike in heart trouble among HIV-infected people in the 1980s and early 1990s, before the advent of life-extending "highly active antiretroviral therapy" (HAART). That suggested that HIV infection, on its own, might boost cardiovascular risks.

According to Lundgren, a study published in the New England Journal of Medicine last November did find a link between untreated HIV infection and accelerated heart disease.

"This effect was likely explained by a complex process where untreated HIV depletes the 'good' (HDL) cholesterol," he said.

Dr. Steven Grinspoon, the researcher who led this week's study from Harvard, also theorized that HIV infection spurs a state of chronic inflammation that could undermine cardiovascular health.

But what about the role of the powerful drugs included in HAART? Typically, these drugs fall into a variety of classes, including enzyme-targeted agents called protease inhibitors.