Exercise Stress Testing for Detection of Silent Myocardial Ischemia in Human Immunodeficiency Virus-Infected Patients Receiving Antiretroviral Therapy [Duong M et al. CID 2002;34:523] This is a study from France to determine the frequency of silent myocardial ischemia in patients with HIV who have received HAART for over 12 months and had no prior known coronary artery disease. The patients underwent exercise stress tests, which were positive in 11 of 99 patients (11%). Multivariate analysis showed age, central fat accumulation and cholesterol levels were independently associated with positive stress tests.
The authors recommend stress tests in patients with HIV who have central fat accumulation and increased cholesterol levels.
Comment: The authors conclude that the frequency of silent myocardial ischemia (11%) was substantially higher than expected, and they also claim that this is the first study to prospectively evaluate a stress test for detection of silent myocardial ischemia in HIV-infected patients. There were no conclusions about the role of PIs in this association since nearly all participants were receiving these drugs. The authors point out the "striking similarities" between fat redistribution syndrome with HIV and metabolic syndrome X, which is relatively frequent in the general population and consists of insulin resistance, abdominal visceral obesity, hypertension, type II diabetes, and an atherogenic plasma-lipid profile. These observations strengthen the current recommendations for interventions to prevent cardiovascular disease, including the use of lipid-lowering agents.
posted 2/20/2002

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