Long-term risk: comprehensive assessment

The evidence of the D:A:D study and the retrospective cohort studies is drawn from a relatively short follow-up period compared to classic studies of cardiovascular risk, which follow patients for fifteen to twenty years. In the absence of such lengthy follow-up, clinicians have had to extrapolate based on lipid, glucose and body composition changes. This requires asking a number of questions:

  • What is the existing risk of heart disease in the population?
  • What are the metabolic changes which predict heart disease in all adults?
  • What patterns of metabolic changes occur in people taking antiretroviral therapy?
  • What can we conclude about the effects of antiretroviral therapy on coronary heart disease risk?
  • How do we weigh the risks of heart disease due to HAART against the risks of failing to treat HIV infection?

The most comprehensive analysis to date has been carried out by Matthias Egger of the University of Bristol, who used a number of different datasets to model the possible impact of metabolic changes on heart disease risk. Baseline risk factors in the HIV-negative male population (Caerphilly Heart Disease study) predict the following corresponding risks of fatal and non-fatal coronary heart disease over 15 to 20 years of follow-up:

  • Ever smoked: 2.3-fold increase in risk compared to non-smokers.
  • Diabetes or impaired glucose tolerance (fasting glucose 6 to 7mm): 2.3-fold increase in risk.
  • Triglycerides above 2.0mm (175mg/dl): 1.8-fold increase in risk.
  • High blood pressure (above 140 / 90): 1.5-fold.
  • Cholesterol above 5.2mm (200mg/dl): 1.5-fold.
  • Reduced HDL cholesterol (below 1.0mm or 38mg/dl): 1.4-fold.

Egger then used data gathered by Andrew Carr in Sydney (in which the average age was 40, and 98% of participants were male) to assess the severity of metabolic changes in HAART patients.  These were compared with the relative risks for people with elevated cholesterol levels and other metabolic changes derived from the Caerphilly study.

This assessment found that HAART resulted in a risk increase ranging from 1.3 to 4-fold higher, with impaired glucose tolerance alone associated with the smallest increase in risk, and the combination of diabetes, elevated cholesterol and elevated triglycerides associated with the greatest increase in risk.

Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.