Desai Manisha, Joyce Vilija, Bendavid Eran, Olshen Richard A, Hlatky Mark, Chow Adam, Holodniy Mark, Barnett Paul, Owens Douglas K
Quantitative Sciences Unit, Center for Biomedical Informatics Research, Department of Medicine Division of Biostatistics, Department of Health Research & Policy, Stanford University.
VA Palo Alto Health Care System.
Clin Infect Dis. 2015 Aug 1;61(3):445-52. doi: 10.1093/cid/civ316. Epub 2015 Apr 22.
To characterize the association of antiretroviral drug combinations on risk of cardiovascular events.
Certain antiretroviral medications for human immunodeficiency virus (HIV) have been implicated in increasing risk of cardiovascular disease. However, antiretroviral drugs are typically prescribed in combination. We characterized the association of current exposure to antiretroviral drug combinations on risk of cardiovascular events including myocardial infarction, stroke, percutaneous coronary intervention, and coronary artery bypass surgery. We used the Veterans Health Administration Clinical Case Registry to analyze data from 24 510 patients infected with HIV from January 1996 through December 2009. We assessed the association of current exposure to 15 antiretroviral drugs and 23 prespecified combinations of agents on the risk of cardiovascular event by using marginal structural models and Cox models extended to accommodate time-dependent variables.
Over 164 059 person-years of follow-up, 934 patients had a cardiovascular event. Current exposure to abacavir, efavirenz, lamivudine, and zidovudine was significantly associated with increased risk of cardiovascular event, with odds ratios ranging from 1.40 to 1.53. Five combinations were significantly associated with increased risk of cardiovascular event, all of which involved lamivudine. One of these-efavirenz, lamivudine, and zidovudine-was the second most commonly used combination and was associated with a risk of cardiovascular event that is 1.60 times that of patients not currently exposed to the combination (odds ratio = 1.60, 95% confidence interval, 1.25-2.04).
In the VA cohort, exposure to both individual drugs and drug combinations was associated with modestly increased risk of a cardiovascular event.
描述抗逆转录病毒药物组合与心血管事件风险之间的关联。
某些用于治疗人类免疫缺陷病毒（HIV）的抗逆转录病毒药物被认为会增加心血管疾病风险。然而，抗逆转录病毒药物通常是联合使用的。我们描述了当前暴露于抗逆转录病毒药物组合与心血管事件风险之间的关联，这些心血管事件包括心肌梗死、中风、经皮冠状动脉介入治疗和冠状动脉搭桥手术。我们使用退伍军人健康管理局临床病例登记处的数据，分析了1996年1月至2009年12月期间24510例HIV感染患者的数据。我们通过使用边际结构模型和扩展以适应时间依赖性变量的Cox模型，评估了当前暴露于15种抗逆转录病毒药物和23种预先指定的药物组合与心血管事件风险之间的关联。
在超过164059人年的随访中，934例患者发生了心血管事件。当前暴露于阿巴卡韦、依非韦伦、拉米夫定和齐多夫定与心血管事件风险增加显著相关，比值比在1.40至1.53之间。五种组合与心血管事件风险增加显著相关，所有这些组合都包含拉米夫定。其中之一——依非韦伦、拉米夫定和齐多夫定——是第二常用的组合，与心血管事件风险的关联是当前未暴露于该组合患者的1.60倍（比值比 = 1.60，95%置信区间，1.25 - 2.04）。
在退伍军人事务部队列中，暴露于单一药物和药物组合均与心血管事件风险适度增加相关。
