Rates for MI per 1,000 years of patient observation for patients on protease inhibitors were compared with rates for patients followed in the identical trials who were not taking the protease inhibitor. The mean follow-up of patients in these studies was one year. The rates of MIs was similar in patients on protease inhibitors or reverse transcriptase inhibitors alone. The authors also stated that these MI rates were consistent with those in the HIV-uninfected men of comparable age. We can only conclude from these epidemiology studies that there does not appear to be an increased risk of heart disease in patients on protease inhibitors over a limited period of observation.
Atherosclerosis develops over years.
We should not necessarily expect to see an increase in MI rates in a group of individuals who are, in general, young and at low risk for heart disease given that any increase in risk that they are currently experiencing has accrued over a relatively short period of time. I believe that we need more studies similar to those reported above. High resolution ultrasound provides a non-invasive methodology that we can use to evaluate anatomical and functional changes in blood vessels. Changes that we observe will provide a valuable surrogate endpoint so that we can assess the risks our patients face for accelerated atherosclerosis, and hopefully, we can make some meaningful observations before our patients present with chest pain. This technique will be particularly useful when employed prospectively to compare the risks associated with different antiretroviral treatment strategies.