Cardiovascular + lung cancer risk and HIV

A few “Snapshots” from the Inflammation and Age-related Complications session, of interest:

1.       An update of D.A.D. data looking the association of cardiovascular disease and contemporarily used protease inhibitors, Atazanavir and Darunavir: Analysis looked at a prospective 7 years’ median follow-up (IQR 6.3 – 7.1) of 35,711 participants with 1,157 (3.2%) of participants having cardio and cerebro-vascular events (incidence rate 5.3/1000 PYFU (95% 5.0 5.6).  The analysis, with which we are now familiar, looked at crude incidence rates of CVD per 1000 PYFU stratified by cumulative use of ATV/r and DRV/r, and MI and Stroke separately. In this analysis, the cumulative use of DRV/r, but not ATV/r was independently associated with a small but increasing risk of 59% per 5 years’ exposure. The strength of the association is of a similar size for the older PIs but in contrast, does not appear to be modified by dyslipidemia.  We were reminded to exercise caution in interpretation as the study is observational only, and there are risks of unmeasured confounding. (L. Ryom et al CROI 2017 # 128LB.)

2.     Investigators in the North American AIDS Cohort Collaboration on Research and Drugs (NA ACCORD) looked at the incidence occurrence of Type 1 MI (atherothrombotic coronary event from plaque rupture) and the association with modifiable traditional risk factors by analysing the Population Attributable Factors (PAF) for MI.  They concluded that 43% of cases of MI in this cohort could have been avoided if these individuals did not have an elevated cholesterol, holding all other variables constant, 41% of MI were avoided by treating hypertension and 38% by smoking prevention. (K. Althoff et al CROI 2017 # 130.)

3.       A further analysis from the D.A.D cohort looked at cessation of cigarette smoking and the impact on cancer incidence. (N= 242 cases of lung cancer, and N=487 cases of smoking related cancers, excluding lung).  There were limitations in the study relating to the collection of cessation dates, intensity, duration or pack years unfortunately. However, the investigators concluded that smoking related cancers, excluding lung cancer, rapidly declined following cessation. Lung cancer incidence appeared to remain elevated in HIV patients several years after cessation, which is in contrast to studies in HIV negative individuals. (L. Shepherd et al CROI 2017 #131.)