The risk of new heart failure associated with protease inhibitor: Systematic scoping review
Maan Gozun, Yoshito Nishimura, Witina Techasatian, Andrew Pham, Kevin Benavente, Jakrin Kewcharoen- Infectious Diseases
- Pharmacology (medical)
- Public Health, Environmental and Occupational Health
- Dermatology
Background
Protease inhibitors (PIs) have contributed to the long-term survival of persons with human immunodeficiency virus (PHIV). While there is a concern linking protease inhibitors to an increased risk of heart failure (HF), the evidence linking protease inhibitors and heart failure has been uncertain.
Methods
Following the PRISMA Extension for Scoping Reviews, we searched MEDLINE and EMBASE for peer-reviewed articles using keywords including “protease inhibitor,” “heart failure,” and “human immunodeficiency virus” from their inception to December 21, 2022.
Results
Five articles, including three observational studies and two randomized controlled trials, were included in the review. While protease inhibitors seem to be associated with atherosclerotic cardiovascular disease through their effects on metabolic markers, there is scarce evidence suggesting a direct association between protease inhibitors and heart failure. Although one study showed a possible correlation between protease inhibitor use and lower left ventricular ejection fraction and increased heart failure admission, the results were subject to confounders, and participants had poor medication adherence.
Conclusion
Although current data are conflicting, there could be an association between PIs and HF in PHIV. Future prospective studies are warranted to evaluate the incidence of heart failure stratified on the generation of PIs and with adjustment for other metabolic risk factors.