Law M G, Friis-Møller N, El-Sadr W M, Weber R, Reiss P, D'Arminio Monforte A, Thiébaut R, Morfeldt L, De Wit S, Pradier C, Calvo G, Kirk O, Sabin C A, Phillips A N, Lundgren J D
AHOD, National Centre in HIV Epidemiology and Clinical Research, UNSW, Sydney, Australia.
HIV Med. 2006 May;7(4):218-30. doi: 10.1111/j.1468-1293.2006.00362.x.
The D:A:D (Data Collection on Adverse Events of Anti-HIV Drugs) Study, a prospective observational study on a cohort of 23 468 patients with HIV infection, indicated that the incidence of myocardial infarction (MI) increased by 26% per year of exposure to combination antiretroviral treatment (CART). However, it remains unclear whether the observed increase in the rate of MI in this population can be attributed to changes in conventional cardiovascular risk factors.
To compare the number of MIs observed among participants in the D:A:D Study with the number predicted by assuming that conventional cardiovascular risk equations apply to patients with HIV infection.
The Framingham equation, a conventional cardiovascular risk algorithm, was applied to individual patient data in the D:A:D Study to predict rates of MI by duration of CART. A series of sensitivity analyses were performed to assess the effect of model and data assumptions. Predictions were extrapolated to provide 10-year risk estimates, and various scenarios were modelled to assess the expected effect of different interventions.
In patients receiving CART, the observed numbers of MIs during D:A:D follow up were similar to or somewhat higher than predicted numbers: 9 observed vs 5.5 events predicted, 14 vs 9.8, 22 vs 14.9, 31 vs 23.2 and 47 vs 37.0 for<1 year, 1-2 years, 2-3 years, 3-4 years and >4 years CART exposure, respectively. In patients who had not received CART, the observed number of MIs was fewer than predicted (3 observed vs 7.6 predicted). Nine per cent of the study population have a predicted 10-year risk of MI above 10%, a level usually associated with initiation of intervention on risk factors.
A consistent feature of all analyses was that observed and predicted rates of MI increased in a parallel fashion with increased CART duration, suggesting that the observed increase in risk of MI may at least in part be explained by CART-induced changes in conventional risk factors. These findings provide guidance in terms of choosing lifestyle or therapeutic interventions to decrease those risk factors in much the same way as in persons without HIV infection.
D:A:D（抗逆转录病毒药物不良事件数据收集）研究是一项针对23468例HIV感染患者队列的前瞻性观察性研究，该研究表明，接受联合抗逆转录病毒治疗（CART）每1年，心肌梗死（MI）的发生率增加26%。然而，尚不清楚在该人群中观察到的MI发生率增加是否可归因于传统心血管危险因素的变化。
比较D:A:D研究参与者中观察到的MI数量与假设传统心血管风险方程适用于HIV感染患者时预测的MI数量。
将传统心血管风险算法弗明汉方程应用于D:A:D研究中的个体患者数据，以根据CART持续时间预测MI发生率。进行了一系列敏感性分析，以评估模型和数据假设的影响。外推预测以提供10年风险估计，并对各种情况进行建模，以评估不同干预措施的预期效果。
在接受CART的患者中，D:A:D随访期间观察到的MI数量与预测数量相似或略高：CART暴露<1年、1 - 2年、2 - 3年、3 - 4年和>4年时，观察到的MI事件分别为9例、14例、22例、第31例和47例，预测事件分别为5.5例、9.8例、14.9例、23.2例和37.0例。在未接受CART的患者中，观察到的MI数量少于预测数量（观察到3例，预测7.6例）。9%的研究人群预测10年MI风险高于10%，这一水平通常与启动危险因素干预相关。
所有分析的一个一致特征是，观察到的和预测的MI发生率随CART持续时间的增加而平行增加，这表明观察到的MI风险增加至少部分可以由CART引起的传统危险因素变化来解释。这些发现为选择生活方式或治疗干预措施以降低这些危险因素提供了指导，与未感染HIV的人群类似。
