Protease inhibitors may increase risk of cardiovascular death in people with HIV and heart failure

Article Published on August 14, 2018

Originally published in Massgeneral.org

Patients with both HIV infection and heart failure (HF) whose antiretroviral regimen includes protease inhibitors may be at greater risk for worsening of HF and cardiovascular (CV) death than those taking non-protease-inhibitor-based regimens
This recent study led by researchers at Mass General is the first to note an effect specifically of ritonavir-boosted protease inhibitor regimens on HF events
In the two years after hospital admission, 35% of those taking ritonavir-boosted protease inhibitors died from CV causes, compared with 17% of those on non-protease-inhibitor antiretroviral regimens

Patients with both HIV infection and heart failure (HF) whose antiretroviral regimen includes ritonavir-boosted protease inhibitors may be at greater risk for worsening of HF and cardiovascular (CV) death than patients with HIV taking non-protease-inhibitor-based regimens. The study, led by Mass General physician Tomas G. Neilan, MD, MPH, director of Mass General's Cardio-Oncology Program, aimed to investigate the broader question of why HF outcomes are worse among patients with HIV.

The research team examined the records for 394 persons with HIV and HF who were receiving antiretroviral therapy and were admitted for worsening HF symptoms to the Bronx-Lebanon Hospital Center of Icahn School of Medicine at Mount Sinai in New York. They found that patients whose antiretroviral therapy included ritonavir-boosted protease inhibitors were more likely to have elevated blood lipids, diabetes, coronary artery disease, elevated pulmonary artery pressure and a reduced left-ventricular emission fraction than those not taking protease inhibitors.

Two years after the initial evaluation, 35% of those taking ritonavir-boosted protease inhibitors died from CV causes, compared with 17% of those on non-protease-inhibitor regimens. Taking a protease inhibitor also doubled – from 34% to 68% – the risk that a patient would need to be readmitted to the hospital within 30 days of discharge.

Dr. Neilan and his colleagues note that larger studies including a more diverse participant group from both inpatient and outpatient settings are required before the findings can be translated into clinical practice.