Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA, USA; Center for Tuberculosis Research, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
School of Public Health, Department of Epidemiology and Biostatistics, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
Int J Antimicrob Agents. 2018 Nov;52(5):541-553. doi: 10.1016/j.ijantimicag.2018.07.010. Epub 2018 Jul 21.
Abacavir's potential to cause cardiovascular disease (CVD) among people living with HIV (PLWH) is debated. We conduct a systematic review and meta-analyses to assess CVD risk from recent and cumulative abacavir exposure.
We searched Medline, Embase, Web of Science, abstracts from Conference on Retroviruses and Opportunistic Infections, and International AIDS Society/AIDS Conferences and bibliographies of review articles to identify research studies published through 2018 on CVD risk associated with abacavir exposure among PLWH. Studies assessing risk of CVD associated with recent (exposure within last 6 months) or cumulative abacavir exposure across all age-groups were eligible. Risks were quantified using fixed- and random-effects models.
Of 378 unique citations, 68 full-text research articles and abstracts were reviewed. Seventeen studies assessed risk of CVD from recent or cumulative abacavir exposure. Summary relative risk (sRR) is increased for recent exposure (n=16 studies, sRR=1.61; 95% confidence interval: 1.48-1.75), higher in antiretroviral-therapy-naive population (n=5, 1.91; 1.48-2.46) and all studies reported RR>1. The sRR for recent exposure was similarly increased for the outcome of acute myocardial infarction, and for studies that adjusted for substance abuse, smoking, prior CVD, traditional CVD risk factors, and CD4 cell-count/HIV viral load. The sRR was increased for cumulative abacavir exposure (per year) (n=4, 1.12; 1.05-1.20) but no increase was seen after adjusting for recent exposure (n=5, 1.00; 0.93-1.08).
Our findings suggest an increased risk of CVD from recent abacavir exposure. The risk remained elevated after adjusting for potential confounders. Further investigations are needed to understand CVD risk from cumulative exposure.
阿巴卡韦是否会导致艾滋病毒感染者（PLWH）发生心血管疾病（CVD）尚存争议。我们进行了一项系统评价和荟萃分析，以评估近期和累积阿巴卡韦暴露与 CVD 风险的关系。
我们检索了 Medline、Embase、Web of Science、逆转录病毒和机会性感染会议摘要以及国际艾滋病协会/艾滋病会议摘要和综述文章的参考文献，以确定截至 2018 年发表的关于 PLWH 中阿巴卡韦暴露与 CVD 风险相关的研究。评估近期（暴露于过去 6 个月内）或所有年龄段累积阿巴卡韦暴露与 CVD 风险相关的研究符合入选标准。使用固定效应和随机效应模型量化风险。
在 378 篇独特的引文中有 68 篇全文研究文章和摘要进行了审查。17 项研究评估了近期或累积阿巴卡韦暴露与 CVD 风险的关系。近期暴露的汇总相对风险（sRR）增加（n=16 项研究，sRR=1.61；95%置信区间：1.48-1.75），在抗逆转录病毒治疗初治人群中（n=5，1.91；1.48-2.46）更高，所有研究报告的 RR>1。近期暴露与急性心肌梗死的结局和调整物质滥用、吸烟、既往 CVD、传统 CVD 危险因素和 CD4 细胞计数/艾滋病毒病毒载量的研究中，sRR 也增加。累积阿巴卡韦暴露（每年）的 sRR 增加（n=4，1.12；1.05-1.20），但在调整近期暴露后（n=5，1.00；0.93-1.08）则无增加。
我们的研究结果表明，近期阿巴卡韦暴露与 CVD 风险增加有关。在调整潜在混杂因素后，风险仍保持升高。需要进一步研究以了解累积暴露的 CVD 风险。
