Acute myocardial infarction associated with abacavir and tenofovir based antiretroviral drug combinations in the United States.
Acute myocardial infarction associated with abacavir and tenofovir based antiretroviral drug combinations in the United States.
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DOI：
10.1186/s12981-021-00383-7
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发表时间：
2021-09-06
影响因子：
2.2
通讯作者：
Reingold AL
中科院分区：
文献类型：
--
作者：
Dorjee K;Desai M;Choden T;Baxi SM;Hubbard AE;Reingold AL
虽然个别抗逆转录病毒药物已被证明与心血管疾病（CVD）风险升高有关，但关于抗逆转录病毒药物组合的作用的数据有限。因此，我们试图调查与抗逆转录病毒药物组合相关的心血管疾病风险。使用行政健康计划数据集，评估了2009年10月至2014年12月在美国接受抗逆转录病毒治疗（ART）的艾滋病毒感染者中与当前暴露于抗逆转录病毒药物组合相关的急性心肌梗死（AMI）风险。为了解释不同适应症的混杂，以及同时作为因果中介和混杂因素的因素，我们对患者的纵向数据应用了治疗加权边际结构模型的逆概率。在接受ART治疗的114,417人/年（n = 73,071人）中，602例AMI发生，发生率为5.26 (95% CI: 4.86, 5.70)/1000人/年。在研究的14种抗逆转录病毒药物组合中，服用阿巴卡韦-拉米夫定-达那韦的患者AMI发生率最高（IR: 11/1000; 95% CI: 7.4-16.0）。目前暴露于abacvir -lamivudine-darunavir（1.91; 1.27-2.88）、abacvir -lamivudine-atazanavir（1.58; 1.08-2.31）和替诺福韦-emtricitabine-raltegravir（1.35; 1.09 - 1.71）的人群发生AMI的风险（HR; 95% CI）升高。替诺福韦-恩曲他滨-依非韦伦与风险降低相关（0.65;0.54-0.78）。阿巴卡韦-拉米夫定-达那韦与AMI风险的增加相关，超过了阿巴卡韦单独使用的预期，可能归因于达那韦联合使用。我们没有发现阿巴卡韦-拉米夫定与依非韦伦或雷替重力韦联合使用会增加AMI的风险。抗逆转录病毒药物组合abacvir -lamivudine-darunavir， abacvir -lamivudine-atazanavir和替诺福韦-emtricitabine-raltegravir与AMI风险升高相关，而替诺福韦-emtricitabine-efavirenz与风险较低相关。与阿巴卡韦-拉米夫定-达那韦相关的AMI风险大于先前描述的阿巴卡韦，这可能表明达那韦增加了风险。这些结果有待进一步的研究证实。在线版本包含补充材料，可在10.1186/s12981-021-00383-7获得。
Although individual antiretroviral drugs have been shown to be associated with elevated cardiovascular disease (CVD) risk, data are limited on the role of antiretroviral drug combinations. Therefore, we sought to investigate CVD risk associated with antiretroviral drug combinations. Using an administrative health-plan dataset, risk of acute myocardial infarction (AMI) associated with current exposure to antiretroviral drug combinations was assessed among persons living with HIV receiving antiretroviral therapy (ART) across the U.S. from October 2009 through December 2014. To account for confounding-by-indication and for factors simultaneously acting as causal mediators and confounders, we applied inverse probability of treatment weighted marginal structural models to longitudinal data of patients. Over 114,417 person-years (n = 73,071 persons) of ART exposure, 602 cases of AMI occurred at an event rate of 5.26 (95% CI: 4.86, 5.70)/1000 person-years. Of the 14 antiretroviral drug combinations studied, persons taking abacavir-lamivudine-darunavir had the highest incidence rate (IR: 11/1000; 95% CI: 7.4–16.0) of AMI. Risk (HR; 95% CI) of AMI was elevated for current exposure to abacavir-lamivudine-darunavir (1.91; 1.27–2.88), abacavir-lamivudine-atazanavir (1.58; 1.08–2.31), and tenofovir-emtricitabine-raltegravir (1.35; 1.07–1.71). Tenofovir-emtricitabine-efavirenz was associated with reduced risk (0.65; 0.54–0.78). Abacavir-lamivudine-darunavir was associated with increased risk of AMI beyond that expected of abacavir alone, likely attributable to darunavir co-administration. We did not find an elevated risk of AMI when abacavir-lamivudine was combined with efavirenz or raltegravir. The antiretroviral drug combinations abacavir-lamivudine-darunavir, abacavir-lamivudine-atazanavir and tenofovir-emtricitabine-raltegravir were found to be associated with elevated risk of AMI, while tenofovir-emtricitabine-efavirenz was associated with a lower risk. The AMI risk associated with abacavir-lamivudine-darunavir was greater than what was previously described for abacavir, which could suggest an added risk from darunavir. The results should be confirmed in additional studies. The online version contains supplementary material available at 10.1186/s12981-021-00383-7.
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影响因子：
4.8
作者：
Fewell, Zoe;Hernan, Miguel A.;Sterne, Jonathan A. C.
通讯作者：
Sterne, Jonathan A. C.
影响因子：
4.2
作者：
Rosenblatt L;Farr AM;Johnston SS;Nkhoma ET
通讯作者：
Nkhoma ET
影响因子：
5
作者：
Cole, Stephen R.;Hernan, Miguel A.
通讯作者：
Hernan, Miguel A.
影响因子：
37.8
作者：
Feinstein MJ;Hsue PY;Benjamin LA;Bloomfield GS;Currier JS;Freiberg MS;Grinspoon SK;Levin J;Longenecker CT;Post WS
通讯作者：
Post WS
影响因子：
4.8
作者：
Kiyota, Y;Schneeweiss, S;Solomon, DH
通讯作者：
Solomon, DH