Parra-Rodriguez Luis, Sahrmann John M, Butler Anne M, Olsen Margaret A, Powderly William G, O'Halloran Jane A
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Open Forum Infect Dis. 2024 Aug 28;11(9):ofae485. doi: 10.1093/ofid/ofae485. eCollection 2024 Sep.
Several antiretroviral therapy (ART) medications have been associated with increased cardiovascular risk, but less is known about the safety of modern ART. We sought to compare the risk of major adverse cardiac events (MACEs) among different ART regimens.
Using insurance claims databases from 2008 to 2020, we identified adults aged <65 years who newly initiated ART. We compared non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens to protease inhibitors (PI)- and integrase inhibitors (INSTI)-based regimens. We used propensity score-weighted Kaplan-Meier functions to estimate the 6, 12, 18, 24, 36, and 48 months' risk and risk differences (RD) of MACE.
Among 37 935 ART initiators (median age, 40 years; 23% female; 26% Medicaid-insured), 45% started INSTI-, 16% PI-, and 39% NNRTI-based regimens. MACE occurred in 418 individuals (1.1%) within 48 months after ART initiation. Compared to NNRTI initiators, the risk of MACE was higher at 12 months (RD, 0.50; 95% CI, 0.14-0.99), 18 months (RD, 0.53; 95% CI, 0.11-1.06), and 24 months (RD, 0.62; 95% CI, 0.04-1.29) for PI initiators, and at 12 (RD, 0.20; 95% CI, 0.03-0.37) and 18 months (RD, 0.31; 95% CI, 0.06-0.54) for INSTI initiators; the precision of estimates was limited for longer duration of follow-up.
Among ART initiators, PI-based and INSTI-based regimens were associated with higher short-term risk of MACE compared to NNRTI-based regimens. The pattern of association between INSTIs and PIs with excess risk of MACE was similar.
几种抗逆转录病毒疗法（ART）药物与心血管风险增加有关，但对于现代ART的安全性了解较少。我们试图比较不同ART方案中主要不良心脏事件（MACE）的风险。
利用2008年至2020年的保险理赔数据库，我们确定了新开始接受ART治疗的65岁以下成年人。我们将基于非核苷类逆转录酶抑制剂（NNRTI）的方案与基于蛋白酶抑制剂（PI）和整合酶抑制剂（INSTI）的方案进行了比较。我们使用倾向评分加权的Kaplan-Meier函数来估计MACE在6、12、18、24、36和48个月时的风险及风险差异（RD）。
在37935名开始接受ART治疗的患者中（中位年龄40岁；23%为女性；26%参加医疗补助保险），45%开始使用基于INSTI的方案，16%开始使用基于PI的方案，39%开始使用基于NNRTI的方案。在开始接受ART治疗后的48个月内，418人（1.1%）发生了MACE。与开始使用NNRTI的患者相比，开始使用PI的患者在12个月时MACE风险更高（RD，0.50；95%CI，0.14 - 0.99），18个月时（RD，0.53；95%CI，0.11 - 1.06），24个月时（RD，0.62；95%CI，0.04 - 1.29）；而开始使用INSTI的患者在12个月时（RD，0.20；95%CI，0.03 - 0.37）和18个月时（RD，0.31；95%CI，0.06 - 0.54）风险更高；对于更长的随访期，估计的精确性有限。
在开始接受ART治疗的患者中，与基于NNRTI的方案相比，基于PI和基于INSTI的方案与更高的短期MACE风险相关。INSTI和PI与MACE额外风险之间的关联模式相似。
