Woolley Ian J, Li Xiuhong, Jacobson Lisa P, Palella Frank J, Ostergaard Lars
Infectious Diseases Department, Alfred Hospital, Monash University Medical School, Prahran 3004, Victoria, Australia.
Sex Health. 2007 Jun;4(2):111-9. doi: 10.1071/sh06052.
There has been increasing concern that HIV-infected individuals may be more at risk for cardiovascular events in the highly-active antiretroviral therapy (HAART) era. This study examined the risk of thromboembolic events in HIV-infected and non-infected individuals and the effect of macrolide prophylaxis on those outcomes.
A subcohort analysis was undertaken using data collected in the Multicenter AIDS Cohort Study to examine the relative risk of vascular events (myocardial infarction, unstable angina and ischaemic stroke). Cox proportional hazard model using age as the time scale with time varying cofactors obtained at each semi-annual visit were used to assess the independent effect of macrolide use.
Controlling for other significant effects including race and smoking, HIV-infection was not independently associated with vascular events. Increased risk was observed among those who used HAART (relative hazard 1.09, 95% confidence intervals 1.00-1.19 in multivariate model), antihypertensive treatment (1.81 [1.26-2.60]), lipid-lowering medication (1.65 [1.12-2.42]), and antibiotics (1.72 [1.25-2.36]). The protective association of macrolide use for a vascular event in the HAART era was also significant (0.10 [0.01-0.75]).
Traditional risk factors are important in the pathogenesis of vascular events in HIV-infected individuals. Macrolide antibiotics may have a protective effect in the HIV-infected individuals in the HAART era.
在高效抗逆转录病毒治疗（HAART）时代，人们越来越担心感染人类免疫缺陷病毒（HIV）的个体发生心血管事件的风险可能更高。本研究调查了HIV感染个体和未感染个体发生血栓栓塞事件的风险，以及大环内酯类药物预防对这些结果的影响。
使用多中心艾滋病队列研究收集的数据进行亚队列分析，以检查血管事件（心肌梗死、不稳定型心绞痛和缺血性中风）的相对风险。使用以年龄为时间尺度的Cox比例风险模型，结合每半年随访时获得的随时间变化的协变量，来评估使用大环内酯类药物的独立效应。
在控制了包括种族和吸烟等其他显著影响因素后，HIV感染与血管事件并无独立关联。在使用HAART的人群（多变量模型中相对风险为1.09，95%置信区间为1.00-1.19）、接受抗高血压治疗的人群（1.81 [1.26-2.60]）、接受降脂药物治疗的人群（1.65 [1.12-2.42]）以及使用抗生素的人群（1.72 [1.25-2.36]）中，观察到风险增加。在HAART时代，使用大环内酯类药物对血管事件的保护关联也很显著（0.10 [0.01-0.75]）。
传统风险因素在HIV感染个体血管事件的发病机制中很重要。在HAART时代，大环内酯类抗生素可能对HIV感染个体具有保护作用。
