Clinical outcome after coronary events in patients treated with HIV-protease inhibitors

The introduction of highly active antiretroviral therapy (HAART) in 1996 has resulted in dramatic improvements in the immune status of HIVinfected patients. As a result, the spectrum of the cardiac manifestations encountered has turned from pericardial and myocardial opportunistic infections occurring in about 5% of patients to miscellaneous cardiac side-effects of drugs among which acute coronary events related to the use of HIV-protease inhibitors are increasingly recognized. In a cohort of 700 HIV-infected patients treated with a combination of two reverse transcriptase inhibitors and one protease inhibitor (HAART), nine (1·3%) suffered acute coronary events between February 1996 and September 1999. All were men (mean age: 40·4 7·6 years), infected with the HIV for several years (first positive HIV-test: 6·9 1·3 years previously) and four of them had experienced previous opportunistic infections before highly active antiretroviral therapy was begun. Their past history also included mild hypercholesterolaemia in one patient, hypertension in another and eight of them were smokers. At presentation for the coronary event, highly active antiretroviral therapy (ritonavir:4; indinavir:5, saquinavir:2) lasted for 17·8 6·6 months and resulted in a complete viral control (HIV viral load 2·3 Log) in eight patients and partly failed in the remaining one (viral load: 5·3 Log). Mean CD4-T-cell count was 200 104/mm. During the period of time ranging from the initiation of highly active antiretroviral therapy and the coronary events, the average peakcholesterol level of patients was 8·07 3·13 mmol . l 1 and the mean peak triglyceride level was 6·6 5·4 mmol . l , i.e. a 168% and 500% increase from mean baseline values, respectively.