Journal
JOURNAL OF INFECTIOUS DISEASES
Volume 201, Issue 3, Pages 318-330Publisher
OXFORD UNIV PRESS INC
DOI: 10.1086/649897
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Funding
- Oversight Committee for the Evaluation of Metabolic Complications of Highly Active Antiretroviral Therapy
- Health Insurance Fund Council, Amstelveen, the Netherlands [CURE/97-46486]
- Agence Nationale de Recherches sur le SIDA
- Australian Government Department of Health and Ageing
- National Institute of Allergy and Infectious Diseases, US National Institutes of Health [U01-AI069907, 5U01AI042170-10, 5U01AI046362-03]
- Foundation for AIDS Research
- Fondo de Investigacion Sanitaria [FIS 99/0887]
- Fundacion para la Investigacion y la Prevencion del SIDA en Espana [FIPSE 3171/00]
- BIOMED 1 [CT94-1637]
- BIOMED 2 [CT97-2713]
- European Commission [QLK2-2000-00773]
- Bristol-Myers Squibb
- GlaxoSmithKline
- Boehringer Ingelheim
- Hoffman-La Roche
- Abbott
- Gilead
- Pfizer
- Swiss National Science Foundation
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Background. The risk of myocardial infarction (MI) in patients with human immunodeficiency virus (HIV) infection has been assessed in 13 anti-HIV drugs in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. Methods. Poisson regression models were adjusted for cardiovascular risk factors, cohort, calendar year, and use of other antiretroviral drugs and assessed the association between MI risk and cumulative (per year) or recent (current or in the past 6 months) use of antiretroviral drugs, with 130,000 person-years of exposure. Results. Over 178,835 person-years, 580 patients developed MI. There were no associations between use of tenofovir, zalcitabine, zidovudine, stavudine, or lamivudine and MI risk. Recent exposure to abacavir or didanosine was associated with an increased risk of MI. No association was found between MI risk and cumulative exposure to nevirapine, efavirenz, nelfinavir, or saquinavir. Cumulative exposure to indinavir and lopinavir-ritonavir was associated with an increased risk of MI (relative rate [RR] per year, 1.12 and 1.13, respectively). These increased risks were attenuated slightly (RR per year, 1.08 [95% confidence interval {CI}, 1.02-1.14] and 1.09 [95% CI, 1.01-1.17], respectively) after adjustment for lipids but were not altered further after adjustment for other metabolic parameters. Conclusions. Of the drugs considered, only indinavir, lopinavir-ritonavir, didanosine, and abacavir were associated with a significantly increased risk of MI. As with any observational study, our findings must be interpreted with caution (given the potential for confounding) and in the context of the benefits that these drugs provide.
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