Adults ages 18 to 34 years who are infected with HIV may be at higher risk for coronary heart disease than uninfected people of the same age, according to an article in the July 17th issue of the Journal of Acquired Immune Deficiency Syndromes.

"Our study suggests that coronary heart disease may be accelerated in younger HIV-infected people," said Dr. Judith Currier, lead author of the study. "It's important for physicians to incorporate heart-disease risk prevention into HIV primary care."

Currier and her associates reviewed 6 years of health records from 28,513 HIV-positive patients and 3,054,696 HIV-negative patients. Both groups were 18 years or older and had been free of heart disease for at least 1 year prior to enrollment with their health plan. The scientists excluded subjects who had been diagnosed with coronary heart disease before they were diagnosed with HIV infection.

After adjustment for factors such as age, gender, antiretroviral therapy, hypertension, and diabetes, Currier and her colleagues compared the rate and risk for coronary heart disease between the 2 populations. Then the researchers evaluated the relationship between drug therapy for HIV infection and the number of first-time coronary events in their group.

The findings surprised the research team. Although the rate of coronary heart disease was low in the HIV-infected adults (men, 18-34 years, women, 18-44 years), it was statistically significantly higher than rates for uninfected peers. The rate for coronary events was 1.64 per 100 patient years for HIV-infected men and 0.76 per 100 patient years for the uninfected peers. Among HIV-infected adults, rates for coronary events among people taking antiretroviral therapy were twice those of people who never received such HIV therapy. Furthermore, there were no statistically significant links between antiretroviral therapy and HIV, or between HIV and coronary heart disease, in men over 34 years of age and women over 44 years of age.

"Coronary heart disease is rare in younger people," said Currier. "Yet HIV infection appears to slightly elevate young adults' risk for heart disease when compared to HIV-negative persons their age."

The findings also suggest a slight association between use of antiretroviral therapy and increased risk for coronary heart disease in younger but not older HIV-infected patients. "The results of this study should not diminish clinicians' enthusiasm for antiretroviral therapy to treat their patients' HIV infection," Currier emphasized. "The benefits of antiretroviral therapy in slowing HIV progression and prolonging patients' lives outweigh its possible cardiac risks."

Currier pointed out that more studies are needed to investigate whether specific antiretroviral agents may contribute to increase risk for coronary heart disease. "Our study was not able to examine the role of specific antiretroviral drugs and increased cardiac risk," she said. "Clearly, more research is needed in this area to draw firm conclusions."

Currier hypothesizes that HIV infection may have less influence on older patients' health because other health conditions and lifestyle choices are far more significant in contribution to overall health. "As people with HIV live longer, their physicians need to address the other diseases that affect HIV-negative patients at their age," said Currier.