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. Author manuscript; available in PMC: 2022 Oct 4.
Published in final edited form as: Can J Cardiol. 2018 Dec 4;35(3):270–279. doi: 10.1016/j.cjca.2018.11.029

Table 1.

Cardiovascular benefits and effects of antiretroviral therapy

Study Population Design Effect of ART
CD4+ Count-Guided Interruption of Antiretroviral Therapy. SMART Study Group. (2006) 5472 persons with HIV with CD4+ > 350 cells/mm3. Mean follow-up of 16 mo. Randomized controlled trial. Viral suppression strategy (uninterrupted maximal suppression of HIV replication with ART) vs drug conservation strategy (deferral of ART until CD4+ < 250 cells/mm3 or development of opportunistic infections). Equal prevalence of PI use in both groups. Increased all-cause mortality (HR, 1.8), serious opportunistic infections (HR, 6.6), and CVD (HR, 1.6) in the drug conservation strategy.
Class of Antiretroviral Drugs and the Risk of Myocardial Infarction. D:A:D Study Group. (2007) 23,437 persons with HIV with median CD4+ of 200 cells/mm3. Median follow-up of 4.5 y per patient. Prospective observational cohort study comprising 188 clinics in 21 countries in Europe, the United States, and Australia. After adjustment for traditional cardiovascular risk factors including total cholesterol and HDL levels, and prior cardiovascular events, the relative rate of MI per year of PI exposure was significantly increased at 1.10.
Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection. INSIGHT START Study Group. (2015) 4685 persons with HIV with CD4+ > 500 cells/mm3. Mean follow-up of 3 y. Randomized controlled trial.
Immediate initiation (start ART immediately) vs deferred initiation (defer ART until CD4+ < 350 cells/mm3, or AIDS).		 Decreased risk of serious AIDS-related event (HR, 0.28) and serious non—AIDS-related event (HR, 0.61) in the immediate initiation group. Two most common non—AIDS-related events were cancer and CVD.

AIDS, acquired immunodeficiency syndrome; ART, antiretroviral therapy; CVD, cardiovascular disease; D:A:D, Data Collection on Adverse Events of Anti-HIV Drugs; HDL, high-density lipoprotein; HIV, human immunodeficiency virus; HR, hazard ratio; PI, protease inhibitor; SMART, Strategies for Management of Antiretroviral Therapy (SMART); START, Strategic Timing of AntiRetroviral Treatment.