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Cardiovascular Disease

Inflammatory Markers and Cardiovascular Risk in Treated and Untreated People with HIV

Two recently published studies shed further light on the relationship between inflammation and non-AIDS conditions in people with HIV. One study found that HIV positive people may have elevated levels of the inflammatory biomarker high-sensitivity C-reactive protein (CRP), even if they are on effective antiretroviral therapy (ART) and otherwise have a low cardiovascular risk. The second study found that people with untreated HIV infection had lower HDL (good) cholesterol and increased levels of inflammatory and coagulation markers compared with HIV negative individuals.

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Body Composition and Metabolic Changes in the SMART Treatment Interruption Trial

Intermittent antiretroviral therapy (ART) was associated with increased subcutaneous fat, but no changes in visceral abdominal fat, according to an analysis from the large SMART treatment interruption trial published in the January 2010 issue of AIDS. In addition, levels of both LDL (bad) and HDL (good) cholesterol decreased, while one measure of blood glucose increased.

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Some Antiretroviral Drugs Linked to Heart Attacks in D:A:D Study, but Overall Risk Remains Small

The latest analysis from the large European D:A:D cohort, reported in the February 1, 2010 Journal of Infectious Diseases, found that use of the antiretroviral drugs indinavir (Crixivan), lopinavir/ritonavir (Kaletra), didanosine (ddI, Videx), and abacavir (Ziagen, also in the Epzicom and Trizivir coformulation) was associated with a significantly increased risk of myocardial infarction (MI). The overall number of heart attacks was small, however, and the researchers said the findings should be interpreted with caution given the potential for confounding and the overall benefits of HIV treatment.

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HIV Positive Men Have More Atherosclerosis and Higher Vascular Age than Uninfected Men

HIV positive men without clinical coronary artery disease were more likely than uninfected men to have atherosclerosis and subclinical signs coronary artery disease, including 6.5% with significant blockage, according to a recent computed tomography study. In this analysis, risk increased with longer duration of HIV infection. A related analysis found that people with HIV had a "vascular age" 15 years greater than their chronological age. This study produced the surprising finding that people with higher CD4 counts were more likely to develop coronary artery disease.

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Abacavir (Ziagen) May Contribute to Impaired Endothelial Function in HIV Patients with Suppressed Viral Load

Abacavir (Ziagen, also in the Epzicom and Trizivir combination pills) may interfere with endothelial function, or normal working of blood vessel linings, impairing blood flow and possibly contributing to the increased risk of cardiovascular events observed in some studies, according to a report in the September 24, 2009 issue of AIDS.

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