Table 1

Assessment of clinical cardiovascular disease (CVD) risk in HIV-infected adults in association with protease inhibitors (PIs) as a class and as individual PIs

CitationStudyNo. of HIV+
patients
No. of HIV controlsCVD risk assessedHR, PI use as a classHR,
PI use by individual drugs
Description of
study type
Ref 6 Veterans Aging Study, Virtual Cohort27 16855 109AMI1.34 (p=0.06)Controlled for traditional
CVD risk factors.
Ref 25 Meta-analysis to 2010ACS and CVA risk/year.
AMI risk/year.
1.10 (1.05–1.17).
1.41 (1.20–1.65).
Ref 26 Meta-analysis, 11 studies2442ACS, AMI risk at 25.5 months2.68 (1.89–3.89)
Ref 22 Veteran Affairs Quality Enhancement Research Initiative36 766AMI and CVA1.23 (0.78–1.93) (p=0.57)Years 1993–2001, retrospective,
40 months f/u; 23.9% diabetes, HTN,
↑lipids, tobacco.
Ref 23 Veteran Ageing Cohort Study31 52366 492Heart failure with ejection fractionNS
elevated versus no ART:
PI: 1.80 (1.19–2.75). NNRTI: 1.48 (1.01–2.15).
Ref 11 D:A:D23 437AMI/1000 person-yearsNo PI: 1.00 >6years: 1.10.Adjusted for lipids.
Ref 28 D:A:DATV: 9611.
ATV/r: 37 005.
AMI/overall risk/year.
CVA/overall risk/year.
ATV: 0.80 (0.61–1.03);
ATV/r: 0.99 (0.90–1.08) NS.
ATV: 0.80 (0.61–1.03);
ATV/r: 1.02 (0.98–1.06) NS.
Ref 30 D:A:D35 711CVD IRR/5 yearsIDV 1.47; LPV/r 1.54.
DRV/r 1.53 (1.28–1.84).
ATV/r 1.0 (0.88–1.16) NS.
Ref 18 French Hospital Database289884AMI/overall risk/year1.53 (1.21–1.94)Amprenavir/LPV/r fosamprenavir±/r
1.56 (1.21–2.01).
LPV/r: 1.34 (1.09–1.64).
IDV: NS.
SQV/r: NS.
Ref 17 Meta-analysisEight studies to 2011AMI/overall risk/year2.13 (1.06–4.28)↑Relative risk/year of exposure:
IDV/r: 1.11 (1.05–1.17).
LPV/r: 1.22 (1.01–1.47).
Ref 24 RAMQ705327 681AMI/overall risk/yearLPV: 1.98 (1.24–3.16).
RTV: 2.29 (1.48–3.51).
  • HRs are statistically significant unless otherwise indicated.

  • Antiretroviral drug abbreviations: ATV, atazanavir; DRV, darunavir; IDV, indinavir; LPV, lopinavir; RTV, ritonavir; SQV, saquinavir; r: ritonavir-boosted protease inhibitor.

  • ACS, acute coronary syndrome; AMI, acute myocardial infarction; ART, antiretroviral therapy, CVA, cerebrovascular accident; D:A:D, Data Collection on Adverse Events of Anti-HIV Drugs; f/u, follw up; HTN, hypertension;  IRR, incident rate ratio; NNRTI, non-nucleoside reverse transcriptase inhibitor; NS, not significant; RAMQ, Regie de l’assurance-maladie du Quebec.