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Genetics comparable to other CAD risk factors in HIV
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An unfavorable genetic background was associated with a risk for coronary artery disease that was similar to the risk associated with traditional risk factors among patients with HIV, according to data published in Clinical Infectious Diseases.
“Genetic background is not a destiny,” Philip Tarr, MD, of the infectious diseases service at Kantonsspital Baselland, University of Basel, Switzerland, told Infectious Disease News. “Rather, the effect of one’s genetic makeup can be quantified and compared to other relevant risk factors. An unfavorable genetic background contributed to coronary risk to a similar degree as known risk factors such as hypertension, diabetes or high cholesterol, and HIV-related factors such as certain ART medication exposures.”
Philip Tarr
Tarr and colleagues evaluated the various risk factors associated with coronary artery disease (CAD) events among patients with HIV who were enrolled in studies that were part of the MAGNIFICENT Consortium. They included 571 patients who experienced a first coronary event and 1,304 matched controls. The researchers performed genotyping on the patients to determine their genetic risk scores, based on the presence of 23 CAD-associated single nucleotide polymorphisms.
Among the 571 patients who had a CAD event, 273 had definite MI, 48 had possible MI or unstable angina, 179 had percutaneous coronary interventions, 32 had coronary artery bypass surgeries and 39 had fatal CAD. Most selected covariates were associated with CAD, including high total cholesterol, diabetes, hypertension, smoking, family history, current abacavir treatment and cumulative exposure to lopinavir.
In a multivariate analysis, a higher genetic risk score also was associated with CAD. Patients with CAD were more likely to be in the upper two genetic score quartiles than were controls. The effect of the weighted genetic score, particularly the scores in the fourth quartile (OR=1.47; 95% CI, 1.06-2.04) was similar to the effect of established CAD risk factors.
“It is important that physicians acquire knowledge and develop strategies to deal with and interpret genetic data in a meaningful way,” Tarr said. “Genetic data is best assessed in the context of all other factors that influence important problems in HIV medicine, such as coronary diseases, diabetes and osteoporosis. Even if genetic testing has no immediate clinical utility today, clinicians need to become familiar with it because more and more patients will approach their physicians to help them with interpreting their personal genomes in the near future.”
Tarr said he and colleagues are now applying similar approaches to obesity, osteoporosis and other age-related conditions in the HIV setting.
Philip Tarr, MD, can be reached at Infectious Diseases Service, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland; email: Philip.tarr@unibas.ch.
Disclosure: Tarr reports financial relationships with Gilead, Janssen, MSD and Viiv.
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