Table 3.
Does ART (or Its Components) Increase Risk of CV Disease?
| Study/First Author | No. of Persons/No. of Events | Type of Event | Main Findings Related to ART | Adjustment for CV RF?* | NRTI Effect?† | NNRTI Effect?† | PI Effect?† |
|---|---|---|---|---|---|---|---|
| Randomized, controlled trial | |||||||
| Coplan, 200326 | 10 986/19 | MI | PI vs no PI: 69% (NS) | NA | NA | NA | Yes |
| Phillips, 200827 | 2752 (VS)/31 | CVD | PI exp: 13% increase per y (P =0.06) | Yes | NA | No | Yes |
| Prospective observational studies | |||||||
| Holmberg, 200228 | 5672/21 | CVD | PI vs no PI: increase 6.5-fold (NS) | Yes | NA | NA | Yes |
| Iloeje, 20059 | 7542/127 | CVD | PI vs no PI: increase 71% (P <0.05) | Yes | NA | NA | Yes |
| DAD I, 20075 | 23 437/345 | MI | PI exp: 16% increase per year (P <0.001) | Yes | NA | No | Yes |
| DAD II, 20075 | 10 002/40 | MI | ART: 24% increase per year (P <0.05) | Yes | NA | NA | NA |
| Retrospective observational studies | |||||||
| Mary-Krause, 20037 | 34 976/66 | MI | >18 mts exp to PI: increased risk | Partial | NA | NA | Yes |
| Rickerts, 200029 | 4993/29 | MI | ART exp: increased risk | Partial | NA | NA | NA |
| Administrative databases | |||||||
| Klein, 200730 | 5000/162 | CAD adm (/1000 PY) | Increase 7.1 (PI) vs 4.9 (no PI) (P=0.02) | Partial | NA | NA | Yes |
| Bozzette, 20038 | 36 766/1207 | CAD adm | No change | Partial | NA | No | No |
| Currier, 20033 | 28 513/1360 | CAD adm | Increase, but only in young persons | Partial | NA | NA | NA |
CV RF indicates cardiovascular risk factors; NRTI, nucleoside reverse-transcriptase inhibitor; NNRTI, nonnucleoside reverse-transcriptase inhibitor; PI, protease inhibitor; NS, nonsignificant; NA, not assessed; VS, viral suppression arm of trial; PI exp, protease inhibitor exposure; mts exp to PI, months exposed to protease inhibitors; and CAD adm, hospital admission for coronary artery disease.
*
Was the ART identified after proper adjustment for traditional cardiovascular risk factors?
†
In studies in which ART or components thereof were identified as cardiovascular risk factors, was this effect associated with exposure to a specific ART drug class?