近期使用阿巴卡韦与当代接受抗 HIV 治疗人群中心血管疾病的发生风险

Recent abacavir use and incident cardiovascular disease in contemporary-treated people with HIV.

机构信息

CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK.

出版信息

AIDS. 2023 Mar 1;37(3):467-475. doi: 10.1097/QAD.0000000000003373. Epub 2022 Aug 23.

DOI:10.1097/QAD.0000000000003373

PMID:36001525

Abstract

OBJECTIVE

Assessing whether the previously reported association between abacavir (ABC) and cardiovascular disease (CVD) remained amongst contemporarily treated people with HIV.

DESIGN

Multinational cohort collaboration.

METHODS

RESPOND participants were followed from the latest of 1 January 2012 or cohort enrolment until the first of a CVD event (myocardial infarction, stroke, invasive cardiovascular procedure), last follow-up or 31 December 2019. Logistic regression examined the odds of starting ABC by 5-year CVD or chronic kidney disease (CKD) D:A:D risk score. We assessed associations between recent ABC use (use within the past 6 months) and risk of CVD with negative binomial regression models, adjusted for potential confounders.

RESULTS

Of 29 340 individuals, 34% recently used ABC. Compared with those at low estimated CVD and CKD risks, the odds of starting ABC were significantly higher among individuals at high CKD risk [odds ratio 1.12 (95% confidence interval = 1.04-1.21)] and significantly lower for individuals at moderate, high or very high CVD risk [0.80 (0.72-0.88), 0.75 (0.64-0.87), 0.71 (0.56-0.90), respectively]. During 6.2 years of median follow-up (interquartile range; 3.87-7.52), there were 748 CVD events (incidence rate 4.7 of 1000 persons-years of follow up (4.3-5.0)]. The adjusted CVD incidence rate ratio was higher for individuals with recent ABC use [1.40 (1.20-1.64)] compared with individuals without, consistent across sensitivity analyses. The association did not differ according to estimated CVD (interaction P = 0.56) or CKD ( P = 0.98) risk strata.

CONCLUSION

Within RESPOND's contemporarily treated population, a significant association between CVD incidence and recent ABC use was confirmed and not explained by preferential ABC use in individuals at increased CVD or CKD risk.

摘要

目的

评估在接受当代抗反转录病毒治疗的 HIV 感染者中，阿巴卡韦（ABC）与心血管疾病（CVD）之间的关联是否仍然存在。

设计

多国队列合作研究。

方法

RESPOND 参与者自 2012 年 1 月 1 日或队列入组的最新日期起，随访至首次发生 CVD 事件（心肌梗死、中风、有创性心血管治疗）、最后一次随访或 2019 年 12 月 31 日。Logistic 回归分析了 5 年 CVD 或慢性肾脏病（CKD）D:A:D 风险评分与开始使用 ABC 的几率之间的关系。我们使用负二项回归模型评估了近期使用 ABC（过去 6 个月内使用）与 CVD 风险之间的关联，并对潜在混杂因素进行了调整。

结果

在 29340 名参与者中，34%的人最近使用了 ABC。与 CVD 和 CKD 风险较低的个体相比，CKD 风险较高的个体开始使用 ABC 的几率明显更高[比值比 1.12（95%置信区间=1.04-1.21）]，而 CVD 风险中、高或极高的个体开始使用 ABC 的几率明显更低[0.80（0.72-0.88）、0.75（0.64-0.87）、0.71（0.56-0.90）]。中位随访 6.2 年（四分位间距；3.87-7.52）期间，共发生 748 例 CVD 事件（发生率为每 1000 人年 4.7 例[4.3-5.0]）。与未使用 ABC 的个体相比，近期使用 ABC 的个体的 CVD 发生率调整后的发病率比更高[1.40（1.20-1.64）]，敏感性分析结果一致。根据估计的 CVD（交互 P=0.56）或 CKD（P=0.98）风险分层，该关联没有差异。