Day 60: HAART and cardiovascular events

For a number of years now there has been some concern over the potential for increased risk of cardiovascular events among patients on HAART. Bozzette and colleagues weigh in on the debate with a very large study from the VA system. They compiled relative risk rates from over 41,000 patients between January 1993 and December 2003, comprising over 168,000 person-years of follow up. The date range is such that it covers pre-HAART, early-HAART, and modern-HAART.

The article, published in JAIDS, shows that, not surprisingly, the risk of death declined between 1995 and 2003. If they hadn’t seen that, you would have to ask some serious questions. Of note, risk of serious cardiovascular event was about the same for any death, dropping over time as mortality did. Inpatient stays for myocardial infarction did not increase significantly over the study and there was no significant increase in risk of cardiovascular event for patients on HAART at 2, 4, or 6 years of HAART use.

The authors note that their cohort is mostly older men who are not as advanced in disease progression. However, the large scale nature of the study is reassuring that these adverse events should not affect HAART use on a population level. Certainly, individual patients may have other cardiovascular factors that play into treatment choice.

M. Linde