In previous studies, HAART, especially with PIs, has been associated with dyslipidemia and hyperglycemia, in particular with the decrease of HDL cholesterol. The higher risk of coronary events in HAART patients could be attributable to its effects on lipid and glucose metabolism. "Dyslipidemia is definitely a side effect of HAART," Fichtenbaum told heartwire. "It probably occurs in 50% to 60% of persons taking potent therapy." Further studies, however, are necessary to evaluate whether some HIV treatment regimens are more lipogenic than others. At this point, Fichtenbaum said, one should not make general recommendations, but rather individualize therapy decisions. "Therapeutic considerations should include smoking cessation, the management of lipids and hyperglycemia, and the careful selection of antiretroviral agents, as studies have found nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens may be more heart-friendly than protease inhibitor-based regiments." However, it is not clear what exactly caused the high rate of hospital admissions for CVD, since the present study was "an epidemiologic investigation that gives us broad strokes," said Fichtenbaum. "It was not set up to determine the cause."

Another study presented at the European AIDS Conference evaluated two alternative treatment regimens in terms of cardiac risk and cost effectiveness. The results suggest that for those HIV patients suffering from CVD it may be worthwhile changing from protease inhibitor-based therapy to a nevirapine (Viramune^®, Boehringer Ingelheim)-based regimen. Nevirapine is an NNRTI, which has shown positive effects on serum lipid profiles. A cost analysis, using data from the IMS Health National Prescription Audit Basic Data Report of prescription costs in the US, found that for HIV patients suffering from PI-associated dyslipidemia, switching to nevirapine-based therapy instead of adding a statin or fibrate to their PI-based regimen could save them several hundred dollars per month. Nevirapine therapy costs $323 a month, whereas PI-based treatment plus a statin can amount to $807 a month, the study found. Fichtenbaum says that statins alone were not fully effective in treating HAART-associated dyslipidemia and that many factors play into the choice of the right treatment option for each individual HIV patient. "I would not make a blanket statement on switching from one regimen to another," he explained to heartwire. "If a person has known heart disease I would try to use the least dyslipidemic regimen possible, but not at the expense of inadequately treating the HIV. We are still searching for better treatments."