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Widespread use of HIV drugs has dramatically improved the longevity and quality of life for millions of Americans infected with the virus. New studies show, however, that the long-term use of the antiretroviral agents are not without risk.
Investigators recently reported that incidence of heart attack appears to be increased among HIV-infected patients being treated with a protease inhibitor (PI). Dr. Scott Holmberg and his team evaluated about 3,000 HIV-infected patients treated with drugs for one month to several years. Over a period of a few years, hospital records show that 13 patients experienced a heart attack, or myocardial infarction (MI).
"For comparison, we also looked at 3,000 HIV-infected people who never took PI drugs, followed for a similar length of time, and only two of them had an MI," said Dr. Holmberg.
"That's the bad news," he added. "The good news is that it is still not a common event."
Other studies suggest that the use of PIs and another class of antiviral drugs--the nucleoside reverse transcriptase inhibitors (NRTIs)--are also associated with atherosclerosis, liver problems, pancreatitis, and peripheral neuropathy.
Researchers from the Carolina Cardiovascular Biology Center at the University of North Carolina, Chapel Hill, believe that the adverse effects are linked to damage to energy-producing cells of the body called mitochondria.
Fatty acids in the bloodstream are broken down by mitochrondria, the scientists explain in an editorial published in Arteriosclerosis, Thrombosis and Vascular Biology. When these cells are damaged, however, essential reactions do not take place and fat metabolism is altered, potentially leading to high blood levels of the artery-clogging compounds.
Future experiments to test how the drug therapies affect mitochrondria could lead to safer drugs to combat HIV infection in the future. See below for a list of drugs FDA-approved for treating HIV infection.
ANTIRETROVIRAL DRUGS
NRTIs --Ziagen, Trizivir, Videx, Epivir, 3TC, Combivir, Zerit, d4T, Viread, Hivid, Retrovir, AZT
PIs --Agenerase, Crixivan, Kaletra, Viracept, Norvir, Fortovase, Invirase
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