The book remains open on the relationship between myocardial infarction (MI) and our most commonly used protease inhibitors, according to new study results published in the Journal of Infectious Diseases. Specifically, the study calls into question whether atazanavir (Reyataz) or darunavir (Prezista) use truly increases MI risk, as earlier research has indicated.
The new data derive from a nested case-control study within a large French cohort. It compared 408 people living with HIV (PLWH) who had suffered an MI with 1,250 controls who had not. After adjusting for participants’ entire antiretroviral history, no significant heart attack risk was associated with either atazanavir or darunavir.
There were limiting factors to these findings: Confidence intervals were wide, relatively few participants had been exposed to darunavir (10% of those with MI and 9% of controls), and overall exposure to the two antiretrovirals was relatively short. Nonetheless, the results appear to contradict the landmark D:A:D study, which showed an increased MI risk over time for those on darunavir.
In a related comment published alongside the study, Virginia A. Triant, M.D., M.P.H., and Mark J. Siedner, M.D., M.P.H., of Massachusetts General Hospital, attempted to make sense of these conflicting findings. “Although the results of the present study do not support the findings of the D:A:D study, they also do not contradict the results,” they wrote. The two argued that differences between how each study was conducted did not allow for a definitive answer to the question of MI risk with the two drugs. They suggested that, until more data are available, medical providers continue to consider the possibility of a potentially higher cardiovascular risk when prescribing darunavir.