Protease Inhibitors and Cardiovascular Outcomes in Patients With HIV and Heart Failure
Protease Inhibitors and Cardiovascular Outcomes in Patients With HIV and Heart Failure
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DOI：
10.1016/j.jacc.2018.04.083
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发表时间：
2018-07-31
影响因子：
24
通讯作者：
Neilan, Tomas G.
中科院分区：
文献类型：
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作者：
Alvi, Raza M.;Neilan, Anne M.;Neilan, Tomas G.
人类免疫缺陷病毒（PHIV）感染者的心力衰竭（HF）发病率增加。蛋白酶抑制剂（PI）与不良心脏重塑和血管事件相关;然而，还没有关于PI在PHIV伴HF中使用的数据。结论本研究试图比较特征，心脏结构，方法：这是一项回顾性单中心研究，共纳入394例抗逆转录病毒治疗患者，2011年因HF住院治疗的PHIV患者，按PI和NPI分层。结果：在394例PHIV合并HF患者中（47%为女性，平均年龄60 ± 9.5岁，CD4细胞计数292 ± 206个/mm3），145例（37%）接受PI治疗，249例（63%）接受NPI治疗。所有基于PI的抗逆转录病毒治疗均包含增加剂量的利托那韦。接受PI的PHIV患者高脂血症、糖尿病和冠状动脉疾病（CAD）的发生率较高;肺动脉收缩压（PASP）较高;左心室射血分数较低。在随访中，使用PI与CV死亡率（35% vs. 17%; p <0.001）和30天HF再入院率（68% vs. 34%; p <0.001）增加相关，在所有HF类型中均观察到这种效应。CV死亡率的预测因素包括PI使用、CAD、PASP和免疫抑制。总体而言，PI与CV mortality. CONCLUSIONS的风险增加2倍，PI为基础的方案在PHIV与HF血脂异常，糖尿病，CAD，左心室射血分数较低，和较高的PASP。在随访中，接受PI的PHIV伴HF患者的CV死亡率和30天HF再入院率增加。(C)2018年由美国心脏病学会基金会。
BACKGROUND Incident heart failure (HF) is increased in persons with human immunodeficiency virus (PHIV). Protease inhibitors (PIs) are associated with adverse cardiac remodeling and vascular events; however, there are no data on the use of PIs in PHIV with HF.OBJECTIVES This study sought to compare characteristics, cardiac structure, and outcomes in PHIV with HF who were receiving PI-based versus non-PI (NPI) therapy.METHODS This was a retrospective single-center study of all 394 antiretroviral therapy-treated PHIV who were hospitalized with HF in 2011, stratified by PI and NPI. The primary outcome was cardiovascular (CV) mortality, and the secondary outcome was 30-day HF readmission rate.RESULTS Of the 394 PHIV with HF (47% female, mean age 60 +/- 9.5 years, CD4 count 292 +/- 206 cells/mm(3)), 145 (37%) were prescribed a PI, whereas 249 (63%) were prescribed NPI regimens. All PI-based antiretroviral therapy contained boosted-dose ritonavir. PHIV who were receiving a PI had higher rates of hyperlipidemia, diabetes mellitus, and coronary artery disease (CAD); higher pulmonary artery systolic pressure (PASP); and lower left ventricular ejection fraction. In follow-up, PI use was associated with increased CV mortality (35% vs. 17%; p < 0.001) and 30-day HF readmission (68% vs. 34%; p < 0.001), effects seen in all HF types. Predictors of CV mortality included PI use, CAD, PASP, and immunosuppression. Overall, PIs were associated with a 2-fold increased risk of CV mortality.CONCLUSIONS PI-based regimens in PHIV with HF are associated with dyslipidemia, diabetes, CAD, a lower left ventricular ejection fraction, and a higher PASP. In follow-up, PHIV with HF who are receiving a PI have increased CV mortality and 30-day HF readmission. (C) 2018 by the American College of Cardiology Foundation.