VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas 75216, USA.
Clin Infect Dis. 2011 Jul 1;53(1):84-91. doi: 10.1093/cid/cir269.
Some studies have suggested that exposure to antiretroviral therapy (ART) with abacavir is associated with an increased risk of acute myocardial infarction (AMI).
Using the Veterans Health Administration's Clinical Case Registry we calculated the risk of AMI and cerebrovascular events (CVA) associated with the cumulative use of abacavir and other nucleoside combinations. We also evaluated the impact of pre-existing chronic kidney disease on the selection of abacavir versus tenofovir in the last recorded ART regimen, and on highly active antiretroviral therapy-associated AMI and CVA risks.
A total of 19,424 human immunodeficiency virus-infected patients contributed 76,376 patient-years of follow. After adjusting for age, hypercholesterolemia, hypertension, type 2 diabetes, and smoking, the hazard ratio (HR) for each year of abacavir use was 1.18 (95% confidence interval [CI], .92-1.50; P=.191) for AMI and 1.16 (95% CI, .98-1.37; P=.096) for CVA. Abacavir use was more common among patients with prior chronic kidney disease than was tenofovir use (12.46% versus 7.15%; P=.0001), and chronic kidney disease was associated with a significantly higher risk of AMI (HR, 2.41; 95% CI, 1.73-3.36), and CVA (HR, 1.80; 95% CI, 1.44-2.24). Compared with patients who received neither tenofovir nor abacavir, patients who received tenofovir had lower risk of AMI (HR, 0.16; 95% CI, .08-.33; P=.0001) and CVA (HR, 0.22; 95% CI, .15-.32; P=.001). Use of abacavir was associated with lower risk of CVA (HR, 0.60; 95% CI, .45-.79).
We observed no association between cumulative or current abacavir use and AMI or CVA. Abacavir use was more common than was tenofovir use among patients with prior chronic kidney disease, and chronic kidney disease independently predicted higher rates of AMI and CVA.
一些研究表明，使用含有阿巴卡韦的抗逆转录病毒疗法（ART）与急性心肌梗死（AMI）的风险增加有关。
我们使用退伍军人健康管理局的临床病例登记处，计算了累积使用阿巴卡韦和其他核苷类似物组合与 AMI 和脑血管事件（CVA）相关的风险。我们还评估了慢性肾脏病对最后一次记录的 ART 方案中阿巴卡韦与替诺福韦的选择以及与高效抗逆转录病毒治疗相关的 AMI 和 CVA 风险的影响。
共有 19424 名人类免疫缺陷病毒感染患者提供了 76376 人年的随访。在调整年龄、高胆固醇血症、高血压、2 型糖尿病和吸烟因素后，阿巴卡韦使用每年的危害比（HR）为 1.18（95%置信区间[CI]，0.92-1.50；P=.191），用于 AMI 和 1.16（95% CI，0.98-1.37；P=.096）用于 CVA。与替诺福韦相比，阿巴卡韦在有既往慢性肾脏病的患者中更为常见（12.46%对 7.15%；P=.0001），慢性肾脏病与 AMI（HR，2.41；95%CI，1.73-3.36）和 CVA（HR，1.80；95%CI，1.44-2.24）的风险显著增加相关。与未接受替诺福韦或阿巴卡韦的患者相比，接受替诺福韦治疗的患者 AMI（HR，0.16；95%CI，0.08-0.33；P=.0001）和 CVA（HR，0.22；95%CI，0.15-0.32；P=.001）的风险较低。阿巴卡韦的使用与 CVA（HR，0.60；95%CI，0.45-0.79）的风险降低相关。
我们没有观察到累积或当前阿巴卡韦使用与 AMI 或 CVA 之间存在关联。与替诺福韦相比，阿巴卡韦在有既往慢性肾脏病的患者中更为常见，慢性肾脏病独立预测 AMI 和 CVA 的发生率更高。
