AIDS: a cardiovascular risk increased by 20% for men and 59% for women

The increased cardiovascular risk in HIV-positive patients for the AIDS virus (HIV +) compared to the general population is 20% for men and 59% for women, according to results from the MONICA-APROCO detailed study by the director of the Pasteur Institute in Lille, Professor Philippe Amouyel, the opening of a symposium on the metabolic syndrome in HIV.
The figures speak for themselves
These figures are the result of a comparison between the results of the French MONICA project and those of HIV + patients from the French cohort APROCO. The MONICA project, implemented by the World Health Organization (WHO), presents an overview of heart disease in 21 countries.

Philippe Amouyel mainly attributed this higher metabolic syndrome risk that clinicians have emerged in the late 1990s among HIV +, shortly after the advent of highly active antiretroviral therapy (HAART).

Metabolic syndrome is defined by the presence of at least three of the following five signs: report on high hip size, hypertriglyceridemia, low HDL-cholesterol, blood pressure and elevated fasting glucose.

Although the MONICA-APROCO study has highlighted a higher risk "of 20% men and 59% among women," Philippe Amouyel tempered these results.

In the general population, metabolic syndrome "multiplied by 1.5 to 2 times the risk of cardiovascular events in five to ten years after," he said stressing "the hindsight cohorts of HIV + patients with results for only three or four years. "

"It takes more time and accurate measurement [cardiovascular risk in HIV + patients] can not yet be made."

A second generation of less toxic antiretroviral
Dr. David Zucman, department of Internal Medicine, Foch (Hauts-de-Seine) hospital in Suresnes, recalled that "the metabolic syndrome is associated with exposure and duration of exposure to antiretroviral drugs," including via lipodystrophy.

Lipodystrophy in his present in 50% of patients under treatment, are characterized by uneven distribution of fat, including atrophy at the peripheral level (face, buttocks and thighs) and / or abdominal enlargement. These lipodystrophy, "complex", "play a role in the increased risk," said David Zucman.

However, he told Reuters Health "realize clinically: there is less lipid disturbances before" in HIV + patients, a finding he attributes to the appearance of a "second generation antiretroviral" .

Citing several nucleoside reverse transcriptase inhibitors (NRTIs) he considers "the molecules being abandoned," the first generation molecules are more toxic, he said. "There are now fewer new NRTI toxicity."

"It's the same with protease inhibitors," he said. Those first generation "are highly toxic molecules of a metabolic point of view." However, "those later developments are much less harmful."

"Nothing has yet been published, but we hope to demonstrate that patients treated in 2005, 2006 and beyond will have fewer cardiovascular disorders," he concluded.