Association of Incomplete Adherence to Antiretroviral Therapy With Cardiovascular Events and Mortality in Virologically Suppressed Persons With HIV: The Swiss HIV Cohort Study.
Association of Incomplete Adherence to Antiretroviral Therapy With Cardiovascular Events and Mortality in Virologically Suppressed Persons With HIV: The Swiss HIV Cohort Study.
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抗逆转录病毒治疗不完全依从性与病毒学抑制HIV感染者心血管事件和死亡率的相关性：瑞士HIV队列研究
DOI：
10.1093/ofid/ofab032
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发表时间：
2021-03
影响因子：
4.2
通讯作者：
Swiss HIV Cohort Study
中科院分区：
文献类型：
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作者：
Castillo-Mancilla JR;Cavassini M;Schneider MP;Furrer H;Calmy A;Battegay M;Scanferla G;Bernasconi E;Günthard HF;Glass TR;Swiss HIV Cohort Study
不完全抗逆转录病毒治疗（ART）的依从性，即使足以维持病毒抑制，也与艾滋病毒感染者（PWH）的炎症增强有关。然而，其临床意义尚不清楚。在瑞士HIV队列研究中，无心血管疾病（CVD）史的PWH在2003年至2018年期间开始抗逆转录病毒治疗，并对病毒抑制（<50拷贝/mL）≥6个月进行评估。使用调整后的Cox比例风险模型评估不完全自我报告的ART依从性（上个月漏给剂量≥1或≥2次）与(1)任何CVD事件（心肌梗死、血管重建、脑出血、中风和/或CVD事件导致的死亡）或(2)非CVD相关死亡之间的关系。共纳入6971例PWH患者（74%为男性）（中位年龄[四分位数间距{IQR}]， 39[32-47]岁）。中位随访（IQR）为8（4-11）年，每位参与者收集了14（8 - 23）份依从性问卷。总共有205名（3%）参与者经历了心血管疾病事件，186名（3%）死于与心血管疾病无关的死亡。在纳入缺失数据的调整竞争风险模型中，缺失≥1次ART剂量显示CVD事件的风险增加，但没有统计学意义（危险比[HR]， 1.23; 95% CI, 0.85-1.79; P = 0.28）。缺失≥1次ART剂量的患者，非cvd相关死亡率风险显著增加(HR, 1.44; 95% CI, 1.00-2.07; P =。0.05)和缺失≥2个ART剂量（HR, 2.21; 95% CI, 1.37-3.57; P = .001）。不完全坚持抗逆转录病毒治疗与病毒学抑制的PWH患者非心血管疾病相关死亡率风险增加显著相关。这突出了不坚持抗逆转录病毒治疗作为非艾滋病临床结果驱动因素的潜在作用。
Incomplete antiretroviral therapy (ART) adherence, even if sufficient to maintain viral suppression, is associated with enhanced inflammation in persons with HIV (PWH). However, its clinical implications remain unknown. PWH enrolled in the Swiss HIV Cohort Study without a history of cardiovascular disease (CVD) who initiated ART between 2003 and 2018 and had viral suppression (<50 copies/mL) for ≥6 months were evaluated. The association between incomplete self-reported ART adherence (≥1 or ≥2 missed doses in the last month) and (1) any CVD event (myocardial infarction, revascularization, cerebral hemorrhage, stroke, and/or death due to CVD event) or (2) non-CVD-related death was evaluated using adjusted Cox proportional hazards models. A total of 6971 PWH (74% male) were included in the analysis (median age [interquartile range {IQR}], 39 [32–47] years). The median (IQR) follow-up was 8 (4–11) years, with 14 (8–23) adherence questionnaires collected per participant. In total, 205 (3%) participants experienced a CVD event, and 186 (3%) died a non-CVD-related death. In an adjusted competing risk model where missing data were imputed, missing ≥1 ART dose showed an increased, but not statistically significant, risk for CVD events (hazard ratio [HR], 1.23; 95% CI, 0.85–1.79; P = .28). Non-CVD-related mortality showed a statistically significantly increased risk with missing ≥1 ART dose (HR, 1.44; 95% CI, 1.00–2.07; P = .05) and missing ≥2 ART doses (HR, 2.21; 95% CI, 1.37–3.57; P = .001). Incomplete ART adherence was significantly associated with an increased risk for non-CVD-related mortality in PWH with virologic suppression. This highlights the potential role of nonadherence to ART as a driver of non-AIDS clinical outcomes.
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DOI：
10.1097/qai.0000000000001629
发表时间：
2018-04-15
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Castillo-Mancilla JR;Morrow M;Boum Y;Byakwaga H;Haberer JE;Martin JN;Bangsberg D;Mawhinney S;Musinguzi N;Huang Y;Tracy RP;Burdo TH;Williams K;Muzzora C;Hunt PW;Siedner MJ
通讯作者：
Siedner MJ
DOI：
10.1097/qai.0000000000001450
发表时间：
2017-08-15
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Drozd DR;Kitahata MM;Althoff KN;Zhang J;Gange SJ;Napravnik S;Burkholder GA;Mathews WC;Silverberg MJ;Sterling TR;Heckbert SR;Budoff MJ;Van Rompaey S;Delaney JAC;Wong C;Tong W;Palella FJ;Elion RA;Martin JN;Brooks JT;Jacobson LP;Eron JJ;Justice AC;Freiberg MS;Klein DB;Post WS;Saag MS;Moore RD;Crane HM
通讯作者：
Crane HM
影响因子：
4.2
作者：
Castillo-Mancilla, Jose R.;Brown, Todd T.;Wada, Nikolas I.
通讯作者：
Wada, Nikolas I.
影响因子：
3.7
作者：
Grund B;Baker JV;Deeks SG;Wolfson J;Wentworth D;Cozzi-Lepri A;Cohen CJ;Phillips A;Lundgren JD;Neaton JD;INSIGHT SMART/ESPRIT/SILCAAT Study Group
通讯作者：
INSIGHT SMART/ESPRIT/SILCAAT Study Group
影响因子：
6.4
作者：
Borges, Alvaro H.;O'Connor, Jemma L.;Lundgren, Jens D.
通讯作者：
Lundgren, Jens D.