Clopidogrel Preferred to Reduce Heart Disease Risk in Patients With HIV
Cardiovascular disease (CVD) is the leading cause of non-HIV-related death in HIV-infected persons. The risk of CVD in HIV-infected persons appears to reflect the contribution of a number of factors, including non-HIV-related (traditional) cardiovascular risk factors, chronic inflammation associated with HIV infection, and metabolic adverse effects of antiretroviral therapy. Traditional CVD risk factors, however, are the major determinants of risk in HIV-infected patients and this population carries a high burden of such factors. HIV infection may also be an independent risk factor for CVD, but there is not yet sufficient evidence to consider HIV infection itself a coronary heart disease risk equivalent (eg, in the same manner as diabetes) or to change calculation of risk in the HIV-infected population. In the absence of specific randomized trials in the HIV-infected population, HIV-infected persons should be treated for cardiovascular risk factors according to current national guidelines for reducing risk, including those for aspirin use and for treatment of dyslipidemia, hypertension, and metabolic syndrome. Clopidogrel may be preferred over aspirin to reduce cardiovascular risk in patients with human immunodeficiency virus (HIV), according to research presented at the International Society on Thrombosis and Haemostasis (ISTH) 2021 annual congress. Patients with HIV are at a higher risk of developed cardiovascular disease. Aspirin and clopidogrel are common antiplatelet medications used to reduce the risk of heart disease. The randomized controlled trial compared clopidogrel to aspirin. A total of 22 patients received clopidogrel, 22 received aspirin, and 11 received no treatment for 14 days. The researchers isolated platelets from 6 patients (2 from each group) in human umbilical vein endothelial cells (HUVECs) to assess proinflammatory HUVEC gene expression. Aspirin reduced platelet aggregation to arachidonic acid (AA) significantly compared with clopidogrel (84% vs. 31%, P <.01). Clopidogrel reduced platelet aggregation to adenosine diphosphate (ADP) compared with aspirin (85% vs. 41%, P <.0001). Clopidogrel reduced platelet activation when compared to aspirin, and reduced HUVEC proinflammatory gene expression when compared with no treatment. Platelets of patients treated with aspirin upregulated HUVEC gene expression. The researchers concluded that clopidogrel may be a preferable treatment to lower the risk of cardiovascular disease in patients with HIV. However, larger studies are needed.
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Journal of Blood Disorders and Transfusion