Antiretroviral treatment does not increase a person’s risk for developing heart disease or heart attacks, but does significantly increase survival, say the authors of a large study published in the March 1 issue of the Journal of Acquired Immune Deficiency Syndromes.

Samuel Bozzette, MD, PhD, from the Veterans Affairs San Diego Health Care System, and his colleagues analyzed the medical records of 41,213 HIV-positive veterans who received care through the Veterans Affairs (VA) health system. Nearly all, 98 percent, were male, 83 percent were between 35 and 55 years old, and roughly half were African American.

Overall, the only factors that increased a person’s risk for having a heart attack or dying were older age and previously existing heart problems. African Americans were less likely to have serious heart problems than Caucasians.

Neither antiretrovirals in general, nor any specific class of antiretroviral, was found to increase a person’s risk for heart disease or heart attack, nor did the risk increase the longer a person remained on antiretroviral treatment.

Bozzette’s team realized it was possible that people at higher risk for heart disease, because of factors like smoking or diabetes, may have been treated differently than people without other risk factors. This, the authors suggest, might have masked any potential increased risk from the antiretrovirals. However, when the team conducted a statistical analysis to account for this potential masking, there was still not increased heart attack risk associated with the use of antiretroviral treatment. In fact, Bozzette’s team found that the longer a person was on antiretroviral treatment, the lower their risk of death became.

This study stands in contrast to other studies that have found an association between antiretroviral treatment and an increased risk of cardiovascular disease and heart attacks. Bozzette’s team acknowledges these studies and suggests that, like its own review of sometimes incomplete medical records, cohort studies suffer from some weaknesses. However, given the large number of people in this analysis—compounded by the fact that these results are similar to those of a previous analysis of VA data—Dr. Bozzette’s group concludes that any additional risk that antiretrovirals contribute to heart disease is very small and strongly outweighed by the significant improvement in survival that they provide.