Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO; and.
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
J Acquir Immune Defic Syndr. 2020 Aug 1;84(4):396-399. doi: 10.1097/QAI.0000000000002357.
Several antiretroviral therapy (ART) classes have been associated with increased myocardial infarction (MI) risk. Cardiovascular disease in people living with HIV (PLWH) on integrase strand transfer inhibitors (INSTI) has not been examined. Here we aim to examine this.
Retrospective cohort design study.
We used the IBMMarketScan databases for U.S. commercially insured and Medicaid covered adults to identify PLWH newly initiated on ART between January 1, 2008 and December 30, 2015. Major adverse cardiac event (MACE), a composite of acute MI, ischemic stroke, coronary artery bypass grafting, and percutaneous coronary intervention was the primary outcome. We used calendar time-specific probability-weighted Cox proportional hazards models to estimate hazard ratios and 95% confidence intervals for the association between INSTI use and MACE. We used propensity score weighting methods to account for potential confounding.
Twenty thousand two hundred forty-two new ART initiators were identified. 5069 (25%) PLWH initiated INSTI-based regimens. 203 MACE events occurred; acute MI 16 (0.32%) vs 66 (0.43%), stroke 24 (0.47%) vs 54 (0.36), coronary artery bypass grafting 2 (0.04%) vs 9 (0.06%), percutaneous coronary intervention 7 (0.14%) vs 25 (0.16%) of INSTI users vs non-users. INSTI-based ART was associated with significantly lower risk of MACE events (hazard ratios 0.79; 95% confidence intervals: 0.64 to 0.96) compared with non-INSTI-based regimens.
In this cohort, INSTI-based regimens were associated with a 21% decreased risk of incident cardiovascular disease. These finding require validation in other cohorts and with longer follow-up.
几种抗逆转录病毒疗法（ART）类别与心肌梗死（MI）风险增加有关。尚未研究接受整合酶链转移抑制剂（INSTI）的艾滋病毒感染者（PLWH）的心血管疾病。在此，我们旨在对此进行研究。
回顾性队列设计研究。
我们使用 IBM MarketScan 数据库对美国商业保险和医疗补助覆盖的成年人进行了研究，以确定 2008 年 1 月 1 日至 2015 年 12 月 30 日期间新开始接受 ART 的 PLWH。主要不良心脏事件（MACE），即急性 MI、缺血性中风、冠状动脉旁路移植术和经皮冠状动脉介入治疗的组合是主要结局。我们使用日历时间特异性概率加权 Cox 比例风险模型来估计 INSTI 使用与 MACE 之间的关联的风险比和 95%置信区间。我们使用倾向评分加权方法来考虑潜在的混杂因素。
确定了 2242 名新的 ART 启动者。5069 名（25%）PLWH 开始使用基于 INSTI 的方案。发生了 203 例 MACE 事件；急性 MI 16 例（0.32%）vs 66 例（0.43%），中风 24 例（0.47%）vs 54 例（0.36%），冠状动脉旁路移植术 2 例（0.04%）vs 9 例（0.06%），经皮冠状动脉介入治疗 7 例（0.14%）vs 25 例（0.16%）的 INSTI 使用者与非使用者。与非 INSTI 为基础的方案相比，基于 INSTI 的 ART 与 MACE 事件的风险显著降低（风险比 0.79；95%置信区间：0.64 至 0.96）。
在本队列中，基于 INSTI 的方案与心血管疾病发生率降低 21%相关。这些发现需要在其他队列中并通过更长时间的随访进行验证。
