Metabolic complications of highly active antiretroviral therapy in adult HIV-infected patients with heart failure: A 7-year prospective cohort study

Long-term metabolic complications of highly active antiretroviral therapy (HAART) have been reported in general human immunodeficiency virus (HIV)-infected patients. We sought to determine whether patients with pre-existing heart failure (HF) using HAART are at high risk of subsequent metabolic syndrome (MetS) and cardiovascular complications, compared with HIV-infected patients without pre-existing HF. This is a prospective cohort study of 5 years of follow-up, in which 172 HIV-infected patients were recruited for the comparison of Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:D), a cardiovascular disease (CVD) risk score for HAART, and lab data, between HF patients and age- and gender-matched non-HF patients. HAART was effective for both HIV-infected patients with or without HF, with a similar plasma viral load (PVL) of HIV (r=0.001, P=0.69) and CD4 count for HF patients (r=-0.06, P=0.48). HAART did not increase the risk of CVDs for patients with HF, with comparable D:A:D (R) (r=0.002, P=0.97) and D:A:D (F) (r=0.04, P=0.62) scores. HF patients presented with higher risk of T2DM (r = 0.24, P=0.01), increased total cholesterol (CHO) (r=0.23, P=0.006), compared to baseline. Moreover, patients with HF presented with significantly higher risk of increased LDL (r=0.18, P=0.04) and increased uric acid (r=0.35, P=0.004) in HF patients. In conclusion, HAART was equally effective for HF and non-HF patients, and did not result in more subsequent CVDs or renal toxicities, when compared with patients without HF; however, increased risk of metabolic complications, including T2DM, and increased levels of CHO, LDL, and uric acid, during follow-ups, were present.