Risk of Cardiovascular Events Among Patients Initiating Efavirenz-Containing Versus Efavirenz-Free Antiretroviral Regimens.
Risk of Cardiovascular Events Among Patients Initiating Efavirenz-Containing Versus Efavirenz-Free Antiretroviral Regimens.
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DOI：
10.1093/ofid/ofw061
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发表时间：
2016-03
影响因子：
4.2
通讯作者：
Nkhoma ET
中科院分区：
文献类型：
--
作者：
Rosenblatt L;Farr AM;Johnston SS;Nkhoma ET
在对真实世界数据的分析中，没有证据表明，无论是在意向治疗期还是治疗期的随访中，接受含依非韦伦方案的患者与接受无依非韦伦方案的患者相比，心血管事件的风险增加。背景。Efavirenz （EFV）是一种用于治疗人类免疫缺陷病毒（HIV）感染的抗逆转录病毒药物，可增加血脂水平。由于高脂血症与心血管事件风险增加相关，本研究比较了接受含efv和不含efv抗逆转录病毒治疗的患者的心血管事件风险。方法。年龄在18-64岁的抗逆转录病毒初始HIV阳性（HIV+）患者从商业和医疗补助保险索赔数据库中选择。在2007年1月1日至2013年12月31日期间，要求≥1次抗逆转录病毒药物治疗的患者被分为2组：含efv或不含efv的方案。患者在开始前需要连续入组6个月，在此期间没有CV事件的证据。观察患者从开始到CV事件发生、退组或研究结束。通过心肌梗死、中风、经皮冠状动脉介入治疗或冠状动脉旁路移植术的诊断或程序代码来确定心血管事件。我们计算了未调整的发病率（IRs），并拟合倾向评分加权Cox比例风险模型。结果。在商业数据库中发现了22 212例患者（11 978例含efv， 10 234例无efv），在Medicaid数据库中发现了7400例患者（2943例含efv， 4457例无efv）。心血管事件罕见（商业IR = 396 / 10万人-年；医疗补助IR = 973 / 10万人-年）。在倾向评分加权模型中，商业数据库中含有efv方案的CV事件风险显著降低（风险比[HR] = 0.68； 95%可信区间[CI]， 0.49 -）。93)在Medicaid数据库中没有发现显著差异（HR = 0.83; 95% CI, 0.58 - 1.19）。结论。该分析没有发现在HIV+患者中开始含efv方案的CV事件风险增加的证据。
In this analysis of real-world data, there was no evidence of increased risk of cardiovascular events in patients initiating efavirenz-containing regimens compared to patients initiating efavirenz-free regimens, whether an intent-to-treat or as-treated follow-up period was used. Background. Efavirenz (EFV), an antiretroviral medication used to treat human immunodeficiency virus (HIV) infection, can increase lipid levels. Because hyperlipidemia is associated with increased risk for cardiovascular (CV) events, this study compared the risk of CV events in patients initiating EFV-containing vs EFV-free antiretroviral regimens. Methods. Antiretroviral-naive HIV-positive (HIV+) patients ages 18–64 were selected from commercial and Medicaid insurance claims databases. Patients with ≥1 claim for antiretroviral medications between January 1, 2007 and December 31, 2013 were classified into 2 cohorts: EFV-containing or EFV-free regimens. Patients were required to have 6 months of continuous enrollment before initiation, with no evidence of a CV event during this time. Patients were observed from initiation until the occurrence of a CV event, disenrollment, or study end. Cardiovascular events were identified through diagnosis or procedure codes for myocardial infarction, stroke, percutaneous coronary intervention, or coronary artery bypass graft. We calculated unadjusted incidence rates (IRs) and fit propensity-score-weighted Cox proportional hazards models. Results. There were 22 212 patients (11 978 EFV-containing and 10 234 EFV-free) identified in the commercial database and 7400 patients identified (2943 EFV-containing and 4457 EFV-free) in the Medicaid database. Cardiovascular events were rare (commercial IR = 396 per 100 000 person-years; Medicaid IR = 973 per 100 000 person-years). In propensity-score-weighted models, hazards of CV events were significantly lower for EFV-containing regimens in the commercial database (hazard ratio [HR] = 0.68; 95% confidence interval [CI], .49–.93) No significant difference was found in the Medicaid database (HR = 0.83; 95% CI, .58–1.19). Conclusions. This analysis found no evidence of increased risk of CV events among HIV+ patients initiating EFV-containing regimens.