Risk of cardiovascular disease from antiretroviral therapy for HIV: a systematic review.
Risk of cardiovascular disease from antiretroviral therapy for HIV: a systematic review.
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DOI：
10.1371/journal.pone.0059551
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Desai M
中科院分区：
文献类型：
--
作者：
Bavinger C;Bendavid E;Niehaus K;Olshen RA;Olkin I;Sundaram V;Wein N;Holodniy M;Hou N;Owens DK;Desai M
最近的研究表明，某些抗逆转录病毒治疗 (ART) 药物与心血管疾病的增加有关。我们进行了系统回顾和荟萃分析来总结现有证据，目的是阐明特定 ART 药物是否与心肌梗死 (MI) 风险增加相关。我们检索了 Medline、Web of Science、Cochrane 图书馆以及逆转录病毒和机会性感染会议以及国际艾滋病协会截至 2011 年 6 月的摘要档案，以识别已发表的文章和摘要。符合条件的研究是比较性的，包括心肌梗死、中风或其他心血管事件作为结局。资格筛选、数据提取和质量评估由两名研究人员独立进行。使用随机效应方法和费舍尔联合概率检验来总结证据。 27 项研究符合纳入标准，其中 8 项有助于正式的荟萃分析。基于两项观察性研究的结果表明，最近（通常定义为最近 6 个月内）接触阿巴卡韦（RR 1.92，95% CI 1.51–2.42）和蛋白酶抑制剂（PI）（RR 2.13，95% CI 1.06–4.28）的患者发生 MI 的风险增加。我们的分析还表明，接触茚地那韦（RR 1.11，95% CI 1.05–1.17）和洛匹那韦（RR 1.22，95% CI 1.01–1.47）的风险每增加一年就会增加。我们关于阿巴卡韦和 PI 增加心血管风险的发现与基于随机对照试验二次分析的四项已发表的荟萃分析形成鲜明对比，后者没有发现心血管疾病风险增加。尽管观察性研究涉及特定药物，但证据却好坏参半。此外，随机试验的荟萃分析并未发现阿巴卡韦和 PI 会增加风险。我们在观察环境中暗示特定 ART 的发现提供了足够的证据，以保证在为此目的而设计的研究中进一步调查这种关系。
Recent studies suggest certain antiretroviral therapy (ART) drugs are associated with increases in cardiovascular disease. We performed a systematic review and meta-analysis to summarize the available evidence, with the goal of elucidating whether specific ART drugs are associated with an increased risk of myocardial infarction (MI). We searched Medline, Web of Science, the Cochrane Library, and abstract archives from the Conference on Retroviruses and Opportunistic Infections and International AIDS Society up to June 2011 to identify published articles and abstracts. Eligible studies were comparative and included MI, strokes, or other cardiovascular events as outcomes. Eligibility screening, data extraction, and quality assessment were performed independently by two investigators. Random effects methods and Fisher’s combined probability test were used to summarize evidence. Twenty-seven studies met inclusion criteria, with 8 contributing to a formal meta-analysis. Findings based on two observational studies indicated an increase in risk of MI for patients recently exposed (usually defined as within last 6 months) to abacavir (RR 1.92, 95% CI 1.51–2.42) and protease inhibitors (PI) (RR 2.13, 95% CI 1.06–4.28). Our analysis also suggested an increased risk associated with each additional year of exposure to indinavir (RR 1.11, 95% CI 1.05–1.17) and lopinavir (RR 1.22, 95% CI 1.01–1.47). Our findings of increased cardiovascular risk from abacavir and PIs were in contrast to four published meta-analyses based on secondary analyses of randomized controlled trials, which found no increased risk from cardiovascular disease. Although observational studies implicated specific drugs, the evidence is mixed. Further, meta-analyses of randomized trials did not find increased risk from abacavir and PIs. Our findings that implicate specific ARTs in the observational setting provide sufficient evidence to warrant further investigation of this relationship in studies designed for that purpose.
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