icon_folder.gif   Conference Reports for NATAP  
 
  ICAAC
Interscience Conference on Antimicrobal Agents and Chemotherapy
December 16-19, 2005 Washington DC
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ATV vs NFV: heart disease risk
 
 
  Do Different Protease Inhibitors Used for Human Immunodeficiency Virus Have Varying Effects on Coronary Heart Disease Risk?
 
Reported by Jules Levin
 
E. L. GILLESPIE, C. M. WHITE, C. I. COLEMAN; Univ. of CT/Hartford Hosp., Storrs, CT.
 
Hyperlipidemia increases a patient's risk for coronary heart disease (CHD). Human immunodeficency virus (HIV) patients who develop lipid abnormalities as a result of their highly active anti-retroviral therapy (HAART) may face the same elevation in cardiovascular risk. This study compares the 10-year CHD risk of HIV patients receiving the protease inhibitors (PIs) atazanavir and nelfinavir.
 
Data from a randomized, controlled study evaluating efficacy and safety of atazanavir 400 mg daily (n=101) and nelfinavir 750 mg three times daily (n=100) (as part of HAART including didanosine and stavudine in treatment naive patients) was incorporated into two 5,000 patient Monte Carlo simulations. Probability distributions of baseline low-density lipoprotein (LDL) and high-density lipoprotein (HDL) values and percentage change in LDL and HDL at 48-weeks following PI administration were developed to estimate on-treatment lipid profiles. These distributions of LDL and HDL values were then used to model patients' 10-year CHD risk using the Framingham risk equation for men in the presence or absence of additional CHD risk factors.
 
Results
 
Patients receiving atazanavir had a lower 10-year risk of CHD compared to patients receiving nelfinavir (p<0.001). This lower incidence of CHD with atazanavir was preserved for patients despite smoking status, diagnosis of diabetes mellitus and hypertension (p<0.001 for all comparisons).
 

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Conclusion: Based on our model, selecting a PI, such as atazanavir, which is less likely to be associated with dyslipidemias may reduce patients' risk for developing CHD.