抗逆转录病毒药物使用相关的动脉粥样硬化事件风险与其他原因导致的死亡风险比较。

Comparison of the risks of atherosclerotic events versus death from other causes associated with antiretroviral use.

作者信息

Kwong Grace P S, Ghani Azra C, Rode Richard A, Bartley Lucy M, Cowling Benjamin J, da Silva Barbara, Donnelly Christl A, van Sighem Ard I, Cameron D William, Danner Sven A, de Wolf Frank, Anderson Roy M

机构信息

Department of Infectious Disease Epidemiology, Imperial College London, UK.

出版信息

AIDS. 2006 Oct 3;20(15):1941-50. doi: 10.1097/01.aids.0000247115.81832.a1.

DOI:10.1097/01.aids.0000247115.81832.a1

PMID:16988515

Abstract

BACKGROUND

Studies considering the risk of atherosclerotic disease (AtD) associated with the use of HAART have reported inconsistent results.

METHODS

Data on antiretroviral therapy (ART) use, risk factors for cardiovascular disease (CVD), AtD and death from other causes in 18 603 HIV-infected patients from two established cohorts were evaluated. The relative hazards of AtD and death from other causes were calculated using a proportional hazards competing risks framework. The impact of protease inhibitor (PI)-containing, non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing or PI + NNRTI-containing regimens on these outcomes were compared to nucleoside reverse transcriptase inhibitor (NRTI)-only regimens or stopping therapy, adjusting for known CVD risk factors.

RESULTS

In 77 480 person-years of follow-up (median duration 3.49 years) there were 318 AtD events including 92 myocardial infarctions and 2044 deaths. Older age, hypertension, diabetes mellitus, having smoked and HIV disease stage were significantly associated with increased risk of AtD. PI- and NNRTI-containing regimens significantly reduced the joint risk of either AtD or death from other causes compared to NRTI-only or stopping therapy [hazard ratio (HR) for PI-containing ART, 0.76, 95% confidence interval (CI), 0.73-0.78, P< 0.001; NNRTI-containing ART, 0.69, 95% CI, 0.65-0.74; P< 0.001). PI-containing ART was associated with a borderline significant increased risk of myocardial infarction (cause-specific HR for PI-containing ART 1.19, 95% CI, 1.01-1.40, P = 0.04) but not with increased risk of AtD compared to NRTI-only regimens or stopping therapy (cause-specific HR for PI-containing ART, 1.03, 95% CI, 0.95-1.13, P = 0.44).

CONCLUSIONS

Overall benefits of PI- and NNRTI-based ART in reducing mortality significantly outweigh any risks of AtD in the "short-term" follow-up of this study. Traditional cardiac risk factors play an important role in determining AtD risk status.

摘要

背景

关于使用高效抗逆转录病毒疗法（HAART）与动脉粥样硬化疾病（AtD）风险相关性的研究报告结果并不一致。

方法

对来自两个既定队列的18603名HIV感染患者的抗逆转录病毒疗法（ART）使用情况、心血管疾病（CVD）风险因素、AtD及其他原因导致的死亡数据进行了评估。使用比例风险竞争风险框架计算AtD及其他原因导致死亡的相对风险。将含蛋白酶抑制剂（PI）、含非核苷类逆转录酶抑制剂（NNRTI）或含PI + NNRTI的治疗方案对这些结局的影响与仅使用核苷类逆转录酶抑制剂（NRTI）的方案或停止治疗进行比较，并对已知的CVD风险因素进行了调整。

结果

在77480人年的随访期（中位持续时间3.49年）内，发生了318例AtD事件，包括92例心肌梗死和2044例死亡。年龄较大、高血压、糖尿病、吸烟及HIV疾病分期与AtD风险增加显著相关。与仅使用NRTI或停止治疗相比，含PI和含NNRTI的治疗方案显著降低了AtD或其他原因导致死亡的联合风险[含PI的ART的风险比（HR）为0.76，95%置信区间（CI）为0.73 - 0.78，P < 0.001；含NNRTI的ART的风险比为0.69，95% CI为0.65 - 0.74，P < 0.001]。与仅使用NRTI的方案或停止治疗相比，含PI的ART与心肌梗死风险的增加有临界显著相关性（含PI的ART的病因特异性HR为1.19，95% CI为1.01 - 1.40，P = 0.04），但与AtD风险增加无关（含PI的ART的病因特异性HR为1.03，95% CI为0.95 - 1.13，P = 0.44）。