HAART and the heart: changes in coronary risk factors and implications for coronary risk in men starting antiretroviral therapy

Sterne, JA; May, M; Bucher, HC; Ledergerber, B; Furrer, H; Cavassini, M; Bernasconi, E; Hirschel, B; Egger, M; Swiss, HIV Cohort (2007). HAART and the heart: changes in coronary risk factors and implications for coronary risk in men starting antiretroviral therapy. Journal of internal medicine, 261(3), pp. 255-67. Oxford: Blackwell Scientific Publications 10.1111/j.1365-2796.2006.01761.x

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OBJECTIVES: To estimate changes in coronary risk factors and their implications for coronary heart disease (CHD) rates in men starting highly active antiretroviral therapy (HAART). METHODS: Men participating in the Swiss HIV Cohort Study with measurements of coronary risk factors both before and up to 3 years after starting HAART were identified. Fractional polynomial regression was used to graph associations between risk factors and time on HAART. Mean risk factor changes associated with starting HAART were estimated using multilevel models. A prognostic model was used to predict corresponding CHD rate ratios. RESULTS: Of 556 eligible men, 259 (47%) started a nonnucleoside reverse transcriptase inhibitor (NNRTI) and 297 a protease inhibitor (PI) based regimen. Levels of most risk factors increased sharply during the first 3 months on HAART, then more slowly. Increases were greater with PI- than NNRTI-based HAART for total cholesterol (1.18 vs. 0.98 mmol L(-1)), systolic blood pressure (3.6 vs. 0 mmHg) and BMI (1.04 vs. 0.55 kg m(2)) but not HDL cholesterol (0.24 vs. 0.32 mmol L(-1)) or glucose (1.02 vs. 1.03 mmol L(-1)). Predicted CHD rate ratios were 1.40 (95% CI 1.13-1.75) and 1.17 (0.95-1.47) for PI- and NNRTI-based HAART respectively. CONCLUSIONS: Coronary heart disease rates will increase in a majority of patients starting HAART: however the increases corresponding to typical changes in risk factors are relatively modest and could be offset by lifestyle changes.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Sterne, Jonathan; Furrer, Hansjakob and Egger, Matthias

ISSN:

0954-6820

ISBN:

17305648

Publisher:

Blackwell Scientific Publications

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:52

Last Modified:

04 May 2014 23:15

Publisher DOI:

10.1111/j.1365-2796.2006.01761.x

PubMed ID:

17305648

Web of Science ID:

000244244400006

URI:

https://boris.unibe.ch/id/eprint/22109 (FactScience: 30436)

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