Krsak Martin, Kent David M, Terrin Norma, Holcroft Christina, Skinner Sally C, Wanke Christine
1Tufts Medical Center and Tufts University, Boston, Massachusetts.
2Predictive Analytics and Comparative Effectiveness (PACE) Center, Tufts Medical Center, Boston, Massachusetts.
AIDS Patient Care STDS. 2015 Jun;29(6):307-13. doi: 10.1089/apc.2014.0309. Epub 2015 Apr 9.
Despite combination antiretroviral therapy (cART), people living with HIV (PLWH) continue to have more systemic inflammation and metabolic disturbances than the general population. These risk factors for atherosclerosis and organ dysfunction may be ameliorated by statins. We retrospectively analyzed 438 cART treated PLWH from the Nutrition For Healthy Living (NFHL) cohort to determine the association between statins and myocardial infarction (MI), stroke, and all-cause mortality as a composite. We used Cox proportional hazards regression as our main analysis. The average age was 44 years, 32% were women, and 67 of the 438 subjects used statins. There was no association between statins and our composite endpoint in two separate models [1.26 (0.57-2.79) in statin history model and 0.93 (0.65-1.32) per year in statin duration model]. The composite outcome was significantly associated with CD4 count, age, and smoking status in both models. CD4 count remained significant even after exclusion of mortality from the composite (HR=0.88, p=0.02). Confounding control via propensity scoring and multiple imputations did not change the results. Statins did not have an effect on MI, stroke, and mortality. Interestingly, CD4 count appears to be an important predictor of these outcomes, even after exclusion of death from the composite.
尽管采用了抗逆转录病毒联合疗法（cART），但与普通人群相比，艾滋病毒感染者（PLWH）仍存在更多的全身炎症和代谢紊乱。他汀类药物可能会改善这些动脉粥样硬化和器官功能障碍的危险因素。我们对营养促进健康生活（NFHL）队列中438名接受cART治疗的PLWH进行了回顾性分析，以确定他汀类药物与心肌梗死（MI）、中风和全因死亡率这一综合指标之间的关联。我们将Cox比例风险回归作为主要分析方法。平均年龄为44岁，32%为女性，438名受试者中有67人使用他汀类药物。在两个独立模型中，他汀类药物与我们的综合终点之间均无关联[他汀类药物使用史模型中为1.26（0.57 - 2.79），他汀类药物使用时长模型中每年为0.93（0.65 - 1.32）]。在两个模型中，综合结局均与CD4细胞计数、年龄和吸烟状况显著相关。即使从综合指标中排除死亡率后，CD4细胞计数仍具有显著性（HR = 0.88，p = 0.02）。通过倾向评分和多重插补进行的混杂因素控制并未改变结果。他汀类药物对心肌梗死、中风和死亡率没有影响。有趣的是，即使从综合指标中排除死亡因素，CD4细胞计数似乎仍是这些结局的重要预测指标。
