Cardiovascular and cerebrovascular events in patients treated for human immunodeficiency virus infection
Cardiovascular and cerebrovascular events in patients treated for human immunodeficiency virus infection
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DOI：
10.1056/nejmoa022048
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发表时间：
2003-02-20
影响因子：
158.5
通讯作者：
Louis, TA
中科院分区：
文献类型：
--
作者：
Bozzette, SA;Ake, CF;Louis, TA
背景：与人类免疫缺陷病毒（HIV）感染相关的代谢异常，包括血糖异常和高脂血症，越来越普遍，并且有可能与加速心脑血管疾病相关。方法：我们对1993年1月至2001年6月期间在退伍军人事务机构接受HIV感染治疗的36,766名患者的心脑血管疾病风险进行了回顾性研究。结果：在抗逆转录病毒治疗中，70.2%的患者接受核苷类似物治疗，41.6%的患者接受蛋白酶抑制剂治疗，25.6%的患者接受非核苷逆转录酶抑制剂治疗，疗程中位数分别为17个月、16个月和9个月。大约1000名患者接受了至少48个月的蛋白酶抑制剂联合治疗，大约1000名患者接受了至少24个月的非核苷逆转录酶抑制剂联合治疗。1995年至2001年期间，心脑血管疾病的入院率从每100病人年1.7人下降到0.9人，任何原因造成的死亡率从每100病人年21.3人下降到5.0人。患者水平的回归分析表明，核苷类似物、蛋白酶抑制剂或非核苷逆转录酶抑制剂的使用与心血管或脑血管事件的危险之间没有关系，但抗逆转录病毒药物的使用与任何原因导致的死亡风险降低有关。结论：使用新的HIV治疗方法在死亡率方面有很大的益处，并且这种益处不会因心脑血管事件发生率或相关死亡率的增加而减少。短期内，对血管疾病加速的恐惧不必影响抗逆转录病毒治疗。然而，艾滋病毒感染者的长期生存意味着需要更长期的观察和分析。
BACKGROUND:Metabolic abnormalities associated with human immunodeficiency virus (HIV) infection, including dysglycemia and hyperlipidemia, are increasingly prevalent, and there is concern about the possibility of an association with accelerated cardiovascular and cerebrovascular disease.METHODS:We conducted a retrospective study of the risk of cardiovascular and cerebrovascular disease among the 36,766 patients who received care for HIV infection at Veterans Affairs facilities between January 1993 and June 2001.RESULTS:For antiretroviral therapy, 70.2 percent of the patients received nucleoside analogues, 41.6 percent received protease inhibitors, and 25.6 percent received nonnucleoside reverse-transcriptase inhibitors for a median of 17 months, 16 months, and 9 months, respectively. Approximately 1000 patients received combination therapy with a protease inhibitor for at least 48 months, and approximately 1000 patients received combination therapy with a nonnucleoside reverse-transcriptase inhibitor for at least 24 months. Between 1995 and 2001, the rate of admissions for cardiovascular or cerebrovascular disease decreased from 1.7 to 0.9 per 100 patient-years, and the rate of death from any cause decreased from 21.3 to 5.0 deaths per 100 patient-years. Patient-level regression analyses indicated that there was no relation between the use of nucleoside analogues, protease inhibitors, or nonnucleoside reverse-transcriptase inhibitors and the hazard of cardiovascular or cerebrovascular events, but the use of antiretroviral drugs was associated with a decreased hazard of death from any cause.CONCLUSIONS: Use of newer therapies for HIV was associated with a large benefit in terms of mortality that was not diminished by any increase in the rate of cardiovascular or cerebrovascular events or related mortality. Fear of accelerated vascular disease need not compromise antiretroviral therapy over the short term. However, prolonged survival among HIVinfected patients means that longer-term observation and analysis are required.