CAD Risk Factors in HIV- Infected Patients

In 1998, Henry and colleagues (Lancet) reported 2 cases of myocardial infarction in young men with HIV disease receiving protease inhibitor-including antiretroviral therapy. The report of these cases was followed by more than a dozen additional case reports, generating considerable concern about accelerated atherosclerosis in HIV-infected patients receiving potent antiretroviral therapy. Coronary artery disease (CAD) risk has thus recently emerged as an important clinical concern; Dr Glesby noted, however, that cardiac involvement is relatively common in advanced HIV infection (including pericardial effusion, endocarditis, and cardiomyopathy), and that CAD risk factors and atherosclerosis were described in HIVinfected patients in the early years of the epidemic. Reports of risk factors prior to the era of potent antiretroviral therapy include observation of hypertriglyceridemia and decreased high-density lipoprotein (HDL) cholesterol levels (Grunfeld et al, Am J Med, 1989); increased plasma levels of endothelial cell products (eg, von Willebrand factor, tissue plasminogen activator; Lafeuillade et al, J Acquir Immune Defic Syndr, 1992); and vascular endothelial damage and significant coronary artery stenoses in autopsy series in children and young adults (Joshi et al, Pediatr Pathol, 1987; Paton et al, Res Virol, 1993). Despite mounting evidence, however, there are no definitive data indicating that CAD is accelerated in the setting of treated or untreated HIV infection (compared to a matched HIVseronegative adult population).