HIV Digest	HIV Digest Archive

New research raises the possibility that lifesaving AIDS drugs may also increase the risk of heart trouble, although experts say the medicines' benefits still far outweigh any hazard. Conflicting studies of the question of drug combinations and their effect on the heart were released in Seattle at the Ninth Conference on Retroviruses and Opportunistic Infections. The drug combinations have been in widespread use for about six years and have prevented thousands of AIDS deaths. However, clinicians are still learning about possible long-term effects.

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Some of these effects quickly become apparent, including odd distribution of body fat and a variety of metabolic abnormalities, such as changes in cholesterol. Longer-term effects on the heart are unclear. Some of the strongest evidence of a possible heart risk comes from a large study conducted by the CDC. It suggests that the overall risk is low, because most patients are relatively young. Nevertheless, those on the drugs have about five times the usual risk of heart attacks. A study of US veterans has found no increase in heart risk. "It's not possible to say which is right," said Dr. Harold Jaffe, the CDC's acting AIDS chief. "The question is important and will get much more attention in coming years."

Dr. Scott Holmberg and other from the CDC followed the health of 5,676 HIV-infected individuals in eight cities from 1993 to 2001. Half took protease

inhibitors. Holmberg found heart attacks were rare. Nevertheless, there were 13 among those getting protease inhibitors, compared with just two among individuals who did not take the medicine. Another study, led by Dr. Samuel Bozette of the University of California at San Diego questioned whether patients have actually had more heart problems since the introduction of drug combination therapy. He examined the records of 36,766 HIV-infected veterans over the same period as the CDC's review. There were about 1,800 hospital admissions for heart disease and strokes. He concluded that if anything, there was a slight decline in heart disease and strokes.

"Drug use is going up tremendously. Survival is going up tremendously. But this complication does not seem to be changing," said Bozette, whose study was partially funded by drug makers.

A small study at the Kaiser Permanente health plan in Oakland, California, found no increase in heart trouble among HIV-infected patients after the introduction of protease inhibitors. The researchers did find that heart disease was twice as common among people with HIV than in those without, and they concluded that the virus itself, rather than treatment, might be the explanation.

Editor's Note: from the Associated Press