蛋白酶抑制剂与 HIV 合并心力衰竭患者的心血管结局。
Protease Inhibitors and Cardiovascular Outcomes in Patients With HIV and Heart Failure.
机构信息
Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Department of Internal Medicine, Bronx-Lebanon Hospital Center of Icahn School of Medicine at Mount Sinai, Bronx, New York; Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Division of Infectious Diseases, Department of Medicine and Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
出版信息
J Am Coll Cardiol. 2018 Jul 31;72(5):518-530. doi: 10.1016/j.jacc.2018.04.083.
BACKGROUND
Incident heart failure (HF) is increased in persons with human immunodeficiency virus (PHIV). Protease inhibitors (PIs) are associated with adverse cardiac remodeling and vascular events; however, there are no data on the use of PIs in PHIV with HF.
OBJECTIVES
This study sought to compare characteristics, cardiac structure, and outcomes in PHIV with HF who were receiving PI-based versus non-PI (NPI) therapy.
METHODS
This was a retrospective single-center study of all 394 antiretroviral therapy-treated PHIV who were hospitalized with HF in 2011, stratified by PI and NPI. The primary outcome was cardiovascular (CV) mortality, and the secondary outcome was 30-day HF readmission rate.
RESULTS
Of the 394 PHIV with HF (47% female, mean age 60 ± 9.5 years, CD4 count 292 ± 206 cells/mm), 145 (37%) were prescribed a PI, whereas 249 (63%) were prescribed NPI regimens. All PI-based antiretroviral therapy contained boosted-dose ritonavir. PHIV who were receiving a PI had higher rates of hyperlipidemia, diabetes mellitus, and coronary artery disease (CAD); higher pulmonary artery systolic pressure (PASP); and lower left ventricular ejection fraction. In follow-up, PI use was associated with increased CV mortality (35% vs. 17%; p < 0.001) and 30-day HF readmission (68% vs. 34%; p < 0.001), effects seen in all HF types. Predictors of CV mortality included PI use, CAD, PASP, and immunosuppression. Overall, PIs were associated with a 2-fold increased risk of CV mortality.
CONCLUSIONS
PI-based regimens in PHIV with HF are associated with dyslipidemia, diabetes, CAD, a lower left ventricular ejection fraction, and a higher PASP. In follow-up, PHIV with HF who are receiving a PI have increased CV mortality and 30-day HF readmission.
背景
人类免疫缺陷病毒（HIV）感染者中心力衰竭（HF）事件发生率增加。蛋白酶抑制剂（PI）与不良心脏重构和血管事件相关；然而，目前尚无 HIV 合并 HF 患者使用 PI 的相关数据。
目的
本研究旨在比较 HIV 合并 HF 患者中接受基于 PI 与非 PI（NPI）治疗的患者的特征、心脏结构和结局。
方法
这是一项回顾性单中心研究，纳入了 2011 年因 HF 住院的所有 394 例接受抗逆转录病毒治疗的 HIV 患者，按 PI 和 NPI 进行分层。主要结局是心血管（CV）死亡率，次要结局是 30 天 HF 再入院率。
结果
在 394 例 HF 的 HIV 患者中（47%为女性，平均年龄 60±9.5 岁，CD4 计数 292±206 个细胞/mm），145 例（37%）接受 PI 治疗，249 例（63%）接受 NPI 治疗。所有基于 PI 的抗逆转录病毒治疗均包含增效剂量利托那韦。接受 PI 治疗的 HIV 患者高脂血症、糖尿病和冠状动脉疾病（CAD）发生率更高；肺动脉收缩压（PASP）更高；左心室射血分数更低。随访中，PI 组 CV 死亡率（35% vs. 17%；p<0.001）和 30 天 HF 再入院率（68% vs. 34%；p<0.001）均升高，且在所有 HF 类型中均观察到这些结果。CV 死亡率的预测因素包括 PI 使用、CAD、PASP 和免疫抑制。总体而言，PI 与 CV 死亡率增加 2 倍相关。
结论
HF 的 HIV 患者中基于 PI 的方案与血脂异常、糖尿病、CAD、左心室射血分数降低和 PASP 升高有关。随访中，接受 PI 治疗的 HF 的 HIV 患者 CV 死亡率和 30 天 HF 再入院率增加。
Zotero 插件