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Protease inhibitor therapy ups risk of premature carotid lesions: study
  Last Updated: 2004-05-14 12:45:17 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Results of a study conducted in Italy provide more evidence that treatment with protease inhibitors (PIs) may lead to premature atherosclerotic lesions. "A periodic ultrasonographic study of the vascular wall should be included in the follow-up of HIV-infected patients," investigators recommend in the April 30th issue of the journal AIDS.
Dr. Paolo Maggi from University of Bari and colleagues used color-doppler ultrasound to evaluate the association between antiretroviral therapy (ART) and carotid vessel lesions in a total of 293 normotensive HIV-1-infected patients.
One hundred five patients were being treated with PIs (group 1), 125 were PI-naïve patients being treated with a non-nucleoside reverse transcriptase inhibitor-containing regimen (group 2), and 63 were either ART-naïve or were being treated with two nucleoside reverse transcriptase inhibitors (group 3). All of the treated subjects had been on therapy for at least one year.
"Acquired lesions of the vascular wall" were evident on ultrasonography in 52.4% of patients in group 1 compared with 15.2% and 14.3% of patients in groups 2 and 3, respectively.
The main predictive risk factors for carotid vessel lesions were ART, age, smoking, and a CD4 T-cell count between 200 and 500 cells per microliter. "However, the highest significance was with the use of PI," the team reports.
These findings support findings from a previous study conducted by the same researchers, which showed a higher than expected prevalence of premature carotid vessel lesions in patients treated with PIs compared with PI-naïve patients and healthy controls. (See Reuters Health report Nov. 16, 2000)
PI-containing regimens appear to be "major" players in the premature development of carotid lesions, the authors conclude. Additional studies, they say, are needed to clarify the mechanism involved.
In the meantime, they urge regular ultrasound exams in the general follow up of HIV infected patients. "In the case of rapid and progressive worsening of acquired lesions, the shift toward a PI-sparing combination therapy would be an appropriate choice," they suggest.
AIDS 2004;18:1023-1028.


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