Risk of Myocardial Infarction in Patients with HIV Infection Exposed to Specific Individual Antiretroviral Drugs from the 3 Major Drug Classes: The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study
Risk of Myocardial Infarction in Patients with HIV Infection Exposed to Specific Individual Antiretroviral Drugs from the 3 Major Drug Classes: The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study
复制标题
DOI：
10.1086/649897
复制
发表时间：
2010-02-01
影响因子：
6.4
通讯作者：
Lundgren, Jens
中科院分区：
文献类型：
--
作者：
Worm, Signe Westring;Sabin, Caroline;Lundgren, Jens
背景。在抗 HIV 药物不良事件数据收集 (D:A:D) 研究中，已使用 13 种抗 HIV 药物评估了人类免疫缺陷病毒 (HIV) 感染患者发生心肌梗死 (MI) 的风险。方法。根据心血管危险因素、队列、日历年份和其他抗逆转录病毒药物的使用对泊松回归模型进行了调整，并评估了 MI 风险与累积（每年）或最近（当前或过去 6 个月）使用抗逆转录病毒药物（130,000 人年暴露）之间的关联。结果。在 178,835 人年中，有 580 名患者罹患心肌梗死。替诺福韦、扎西他滨、齐多夫定、司他夫定或拉米夫定的使用与心肌梗死风险之间没有关联。最近接触阿巴卡韦或去羟肌苷与心肌梗死风险增加相关。未发现心肌梗死风险与奈韦拉平、依非韦伦、奈非那韦或沙奎那韦累积暴露之间存在关联。茚地那韦和洛匹那韦-利托那韦的累积暴露与 MI 风险增加相关（每年相对发生率 [RR] 分别为 1.12 和 1.13）。这些增加的风险在调整血脂后略有减弱（每年 RR，分别为 1.08 [95% 置信区间 {CI}，1.02-1.14] 和 1.09 [95% CI，1.01-1.17]），但在调整其他代谢参数后没有进一步改变。结论。在考虑的药物中，只有茚地那韦、洛匹那韦-利托那韦、去羟肌苷和阿巴卡韦与心肌梗死风险显着增加相关。与任何观察性研究一样，我们的研究结果必须在这些药物提供的益处的背景下谨慎解释（考虑到混淆的可能性）。
Background. The risk of myocardial infarction (MI) in patients with human immunodeficiency virus (HIV) infection has been assessed in 13 anti-HIV drugs in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study.Methods. Poisson regression models were adjusted for cardiovascular risk factors, cohort, calendar year, and use of other antiretroviral drugs and assessed the association between MI risk and cumulative (per year) or recent (current or in the past 6 months) use of antiretroviral drugs, with 130,000 person-years of exposure.Results. Over 178,835 person-years, 580 patients developed MI. There were no associations between use of tenofovir, zalcitabine, zidovudine, stavudine, or lamivudine and MI risk. Recent exposure to abacavir or didanosine was associated with an increased risk of MI. No association was found between MI risk and cumulative exposure to nevirapine, efavirenz, nelfinavir, or saquinavir. Cumulative exposure to indinavir and lopinavir-ritonavir was associated with an increased risk of MI (relative rate [RR] per year, 1.12 and 1.13, respectively). These increased risks were attenuated slightly (RR per year, 1.08 [95% confidence interval {CI}, 1.02-1.14] and 1.09 [95% CI, 1.01-1.17], respectively) after adjustment for lipids but were not altered further after adjustment for other metabolic parameters.Conclusions. Of the drugs considered, only indinavir, lopinavir-ritonavir, didanosine, and abacavir were associated with a significantly increased risk of MI. As with any observational study, our findings must be interpreted with caution (given the potential for confounding) and in the context of the benefits that these drugs provide.