Associations between antiretroviral use and subclinical coronary atherosclerosis
Associations between antiretroviral use and subclinical coronary atherosclerosis
复制标题
DOI：
10.1097/qad.0000000000001220
复制
发表时间：
2016-10-23
期刊：
影响因子：
3.8
通讯作者：
Palella, Frank J., Jr.
中科院分区：
文献类型：
--
作者：
Thomas, Guajira P.;Li, Xiuhong;Palella, Frank J., Jr.
目的：人类免疫缺陷病毒(HIV)感染与亚临床冠状动脉斑块的发生率增加有关。这些斑块在多大程度上反映了HIV感染或长期使用抗逆转录病毒疗法(ART)的影响，目前尚不清楚，这是本分析的目标。设计和方法：在多中心艾滋病队列研究中，我们使用冠状动脉计算机断层扫描(CT)比较了服用特定ART药物或药物类别的HIV感染者中冠状动脉斑块和狭窄的患病率和程度。为了考虑时间依赖的混杂因素，包括心血管疾病危险因素和使用特定治疗的时变原因，我们建立了完全调整的Logistic模型和线性模型，其中治疗权重的概率相反。结果：618名男性接受了冠状动脉CT平扫，450人同时接受了冠状动脉CT血管成像。在扫描时，81%的人检测不到血浆HIV RNA。在完全调整的模型中，累积使用齐多夫定、阿巴卡韦、达鲁那韦和蛋白酶抑制剂作为一类药物与特定形式的斑块存在或程度不一致。结论：在广泛暴露于ART的病毒抑制HIV感染男性中，特定ART药物的使用与亚临床冠状动脉斑块的存在和范围没有明显的一致性关联。我们的发现支持一种假设，即在病毒抑制的人中，使用的ART类型通常不是亚临床冠状动脉斑块风险的主要决定因素。
Objectives:HIV infection is associated with increased prevalence of subclinical coronary plaque. The extent to which such plaque reflects effects of HIV infection or effects of long-term antiretroviral therapy (ART) use remains unclear and was the goal of this analysis.Design and methods:We compared the prevalence and extent of coronary plaque and stenosis between users of specific ART drugs or drug classes using coronary computed tomography (CT) among HIV-infected men in the Multicenter AIDS Cohort Study. To account for time-dependent confounders, including cardiovascular disease risk factors and time-varying reasons for using specific treatments, we conducted fully adjusted logistic and linear models with inverse probability of treatment weighting.Results:There were 618 men who underwent noncontrast coronary CT; 450 also underwent coronary CT angiography. At the time of scanning, 81% had undetectable plasma HIV RNA. In fully adjusted models, cumulative use of zidovudine, abacavir, darunavir, and protease inhibitors as a drug class were inconsistently associated with specific forms of plaque presence or extent.Conclusion:Among virally suppressed HIV-infected men with extensive ART exposure, no consistent associations between use of specific ART drugs and both subclinical coronary plaque presence and extent were apparent. Our findings support the hypothesis that, among virally suppressed persons, type of ART used is not in general a major determinant of subclinical coronary plaque risk.