Department of Family Medicine, Maple Leaf Medical Clinic, Toronto, Ontario, Canada.
Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
AIDS Res Hum Retroviruses. 2021 Jan;37(1):44-53. doi: 10.1089/AID.2020.0053. Epub 2020 Nov 2.
Following cardiovascular events (CVE) among people living with HIV (PLWH) is essential. Abacavir (ABC)'s impact on CVE challenges clinicians. We characterized CVE at our HIV clinic associated with ABC versus tenofovir disoproxil fumarate (TDF). This was a retrospective study of PLWH who started combination antiretroviral therapy with no prior CVE. Patients were evaluated as antiretroviral naive or antiretroviral experienced. Regimens included the following: always-ABC, always-TDF, first-ABC-switched-to-TDF, and first-TDF-switched-to-ABC regimens. Frequencies, rates, and Poisson regression were used to analyze CVE (cardiovascular/cerebrovascular) and were stratified with an cutoff of before or after January 1, 2009. 1,440/2,852 patients were antiretroviral naive; 658 on always-ABC regimens, 1,186 on always-TDF regimens, 737 first-ABC-switched-to-TDF regimens, and 271 first-TDF-switched-to-ABC regimens. Seventy seven CVE occurred overall [16 naive vs. 61 experienced ( < .0001)]. Sixty events were cardiovascular and 17 cerebrovascular ( < .0001). Sixty-nine CVE occurred before 2009 and eight after ( < .0001). There were 5.65 CVE-per-1,000-years [95% confidence interval (CI) 3.23-9.87] in the always-ABC, 1.95 CVE-per-1,000-years (95% CI 1.08-3.51) in the always-TDF, 2.01 CVE-per-1,000-years (95% CI 1.14-3.56) in the ABC-switched-to-TDF, and 1.82 CVE-per-1,000-years (95% CI 0.77-4.30) in TDF-switched-to-ABC ( <.01). Multivariable Poisson regression incidence rate ratios (IRRs) revealed that being on ABC-only (IRR 2.89; 95% CI 2.13-3.94), age (IRR 1.06 per year; 95% CI 1.04-1.07), and smoking (IRR for current 2.81; 95% CI 1.97-3.99; IRR for former 2.49; 95% CI 1.72-3.61) increased risk of CVE. Thus, in our clinic, CVE rates were increased in those on ABC and adds to the body of literature suggesting concern.
对 HIV 感染者（PLWH）进行心血管事件（CVE）监测至关重要。阿巴卡韦（ABC）对 CVE 的影响给临床医生带来了挑战。我们在我们的 HIV 诊所对与 ABC 相关的 CVE 进行了特征描述，与替诺福韦二吡呋酯（TDF）进行了比较。这是一项回顾性研究，纳入了从未发生过 CVE 的开始联合抗逆转录病毒治疗的 PLWH。患者被评估为抗逆转录病毒初治或抗逆转录病毒经验丰富。方案包括以下几种：始终使用 ABC、始终使用 TDF、首先使用 ABC 转换为 TDF 以及首先使用 TDF 转换为 ABC。使用频率、比率和泊松回归来分析 CVE（心血管/脑血管），并使用 2009 年 1 月 1 日之前或之后的时间点进行分层。1440/2852 名患者为抗逆转录病毒初治；658 名患者使用 ABC 方案，1186 名患者使用 TDF 方案，737 名患者首先使用 ABC 转换为 TDF 方案，271 名患者首先使用 TDF 转换为 ABC 方案。总体发生了 77 例 CVE[16 例初治与 61 例经验丰富（ < .0001）]。60 例为心血管事件，17 例为脑血管事件（ < .0001）。69 例 CVE 发生在 2009 年之前，8 例发生在之后（ < .0001）。在 ABC 方案中，每 1000 年发生 5.65 例 CVE[95%置信区间（CI）3.23-9.87]；在 TDF 方案中，每 1000 年发生 1.95 例 CVE[95%CI 1.08-3.51]；在 ABC 转换为 TDF 方案中，每 1000 年发生 2.01 例 CVE[95%CI 1.14-3.56]；在 TDF 转换为 ABC 方案中，每 1000 年发生 1.82 例 CVE[95%CI 0.77-4.30]（ <.01）。多变量泊松回归发病率比（IRR）显示，仅使用 ABC（IRR 2.89；95%CI 2.13-3.94）、年龄（IRR 每年 1.06；95%CI 1.04-1.07）和吸烟（当前吸烟的 IRR 为 2.81；95%CI 1.97-3.99；以前吸烟的 IRR 为 2.49；95%CI 1.72-3.61）会增加 CVE 的风险。因此，在我们的诊所中，使用 ABC 的患者 CVE 发生率增加，这增加了文献中对 ABC 相关 CVE 风险的关注。
