Death rates due to cardiovascular or cerebrovascular disease in adults with Human Immunodeficiency Virus infection have decreased even though use of highly active antiretroviral therapy has increased, according to an article in the February 20th issue of the New England Journal of Medicine. Researchers studied records for 36,766 patients treated from 1993 to 2001 before concluding that vascular complications due to antiretroviral therapy are not as common as some physicians had feared.

The research team also found a 75 percent decrease in the overall death rate for the same patient population over the same period, which is consistent with other evidence that use of antiretroviral therapy may prolong survival. "Fears about vascular disease as a side effect of these drugs shouldn't keep patients and their doctors from using the best treatments available, consistent with guidelines," said study leader Samuel A. Bozzette, M.D., Ph.D.

Although the study is the largest of its kind to date, it analyzed data only from an 8-year span, and thus the findings may not reflect the rate of serious vascular disease with longer-term use of such a retroviral therapy regimen.

"It's reasonable to expect that metabolic abnormalities will be harmful to people with HIV over a longer time frame," said Bozzette. He said patients must be monitored carefully for vascular disease and other side effects and treated accordingly.

The increased use of potent combinations of antiretroviral drugs has led to a sharp decline in the number of AIDS-related deaths since 1996. Currently, patients infected with HIV are leading longer, healthier lives. However, the drugs that prolong survival for these patients --usually a combination of reverse transcriptase inhibitors and protease inhibitors--can also cause serious side effects affecting the heart, blood, kidneys, liver, and nervous system.

Because protease inhibitors have been associated with metabolic problems such as diabetes, redistribution of body fat, and abnormalities in fat metabolism, physicians had been concerned that there could be long-term vascular effects resulting in cardiovascular or cerebrovascular events. On the other hand, at the time the study was begun there was also evidence that HIV infection can directly cause vascular disease.
Of the 36,766 patients included in the current study, only 21,659 were still alive at the end of the 8-year study period. However, any-cause mortality decreased sharply from 1993--when 2,273 of 16,763 patients died--to 2001, when 410 of 17,891 patients died.

Ongoing research may provide more answers on possible relationships among antiretroviral therapy for HIV infection, metabolic conditions, and development of vascular disease.