d'Arminio A, Sabin C A, Phillips A N, Reiss P, Weber R, Kirk O, El-Sadr W, De Wit S, Mateu S, Petoumenos K, Dabis F, Pradier C, Morfeldt L, Lundgren J D, Friis-Møller N
Università degli Studi di Milano, Italy.
AIDS. 2004 Sep 3;18(13):1811-7. doi: 10.1097/00002030-200409030-00010.
Recent results from the D:A:D Study indicated that the incidence of myocardial infarction (MI) increased by 26% per year of exposure to combination antiretroviral treatment (CART). The present study was performed to investigate whether this risk was similar when including other cardio- and cerebro-vascular disease events (CCVE).
D:A:D is an international collaboration of 11 cohorts, following 23 468 HIV-infected patients prospectively at 188 clinics in 21 countries situated in Europe, USA and Australia.
The end-point was the occurrence of a first CCVE during prospective follow-up, defined as the first of: acute MI, invasive cardiovascular procedures, stroke, or death from other cardiovascular disease. Relative rates (RR) for CCVE from Poisson regression models and 95% confidence intervals (CI) are reported. All models are adjusted for other risk factors for CCVE, including age, gender, ethnicity, family history, body mass index, and smoking status as well as cohort and HIV transmission group.
Over 36 145 person-years of follow-up, 207 patients experienced at least one CCVE (23.7% fatal). The first event was MI in 126 patients, invasive cardiovascular procedure in 39 patients, stroke in 38 patients, and death from other cardiovascular disease in four patients. The incidence of first CCVE was 5.7 per 1000 person-years [95% confidence interval (CI) 5.0-6.5] and increased with longer exposure to CART (RR per year of exposure, 1.26; 95% CI, 1.14-1.38; P < 0.0001).
CART increases the risk of CCVD, and this increase is comparable with how CART affects the risk of MI. This finding is consistent with the hypothesis that atherosclerosis is a side-effect of CART.
D:A:D研究的近期结果表明，接受联合抗逆转录病毒治疗（CART）每增加一年，心肌梗死（MI）的发病率就会上升26%。本研究旨在调查纳入其他心血管和脑血管疾病事件（CCVE）时，这种风险是否相似。
D:A:D是一项由11个队列组成的国际合作研究，对欧洲、美国和澳大利亚21个国家188家诊所的23468名HIV感染患者进行前瞻性随访。
终点是前瞻性随访期间首次发生CCVE，定义为以下情况中的首次发生：急性心肌梗死、侵入性心血管手术、中风或其他心血管疾病导致的死亡。报告泊松回归模型得出的CCVE相对发生率（RR）和95%置信区间（CI）。所有模型均针对CCVE的其他风险因素进行了调整，包括年龄、性别、种族、家族史、体重指数、吸烟状况以及队列和HIV传播组。
在超过36145人年的随访中，207名患者至少经历了一次CCVE（23.7%为致命事件）。首次事件为心肌梗死的有126例患者（译者注：这里的126例患者经历的首次事件就是心肌梗死，与前文提到的心肌梗死发病率上升相呼应），侵入性心血管手术的有39例患者，中风的有38例患者，其他心血管疾病导致死亡的有4例患者。首次CCVE的发病率为每1000人年5.7例[95%置信区间（CI）5.0 - 6.5]，并且随着接受CART治疗时间的延长而增加（每年暴露的RR为1.26；95% CI，1.14 - 1.38；P < 0.0001）。
CART增加了CCVD的风险，且这种增加与CART对心肌梗死风险的影响相当。这一发现与动脉粥样硬化是CART的副作用这一假设相一致。
