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PIs and CV Outcomes in Patients with HIV and HF

J Am Coll Cardiol; 2018 Jul; Alvi, Neilan, et al

In patients with HIV and heart failure (HF), protease inhibitor-based regimens are associated with dyslipidemia, diabetes, coronary artery disease (CAD), a lower left ventricular ejection fraction, and a higher pulmonary artery systolic pressure (PASP). The retrospective single-center study included all 394 antiretroviral therapy-treated persons with human immunodeficiency virus (PHIV) who were hospitalized with HF in 2011, and stratified by PI and non-PI (NPI). The primary outcome was cardiovascular (CV) mortality and secondary outcome was 30-day HF readmission rate. Researchers found:

  • Of the 394 PHIV with HF (mean age 60 ±9.5 years, 47% female), 145 (37%) were prescribed a PI, while 249 (63%) were prescribed NPI regimens.
  • PHIV who were receiving a PI had higher rates of hyperlipidemia, diabetes mellitus, and CAD; higher PASP; and lower left ventricular ejection fraction.
  • In follow-up, PI was associated with increased CV mortality and 30-day HF readmission.
  • Overall, PIs were associated with a 2-fold increased risk of CV mortality.


Alvi RM, Neilan AM, Tariq N, et al. Protease inhibitors and cardiovascular outcomes in patients with HIV and heart failure. J Am Coll Cardiol. 2018;72(5):518-530. doi:10.1016/j.jacc.2018.04.083.

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