Journal
AIDS RESEARCH AND THERAPY
Volume 18, Issue 1, Pages -Publisher
BMC
DOI: 10.1186/s12981-021-00383-7
Keywords
Human Immunodeficiency Virus; Antiretroviral agents; Cardiovascular disease
Categories
Funding
- US National Institute of Allergy and Infectious Diseases [K01AI148583]
- Johns Hopkins Alliance for a Healthier World [80045453]
- UNOPS STOP TB PARTNERSHIP TB REACH [134126]
- Pittsfield Anti-TB Association
- Paster Family
- Chao Family
Ask authors/readers for more resources
This study investigated the relationship between antiretroviral drug combinations and cardiovascular disease risk, finding that abacavir-lamivudine-darunavir, abacavir-lamivudine-atazanavir, and tenofovir-emtricitabine-raltegravir were associated with an elevated risk of acute myocardial infarction (AMI), while tenofovir-emtricitabine-efavirenz was associated with a lower risk. The results suggest potential added risk from darunavir in the combination therapy.
Introduction Although individual antiretroviral drugs have been shown to be associated with elevated cardiovascular disease (CVD) risk, data are limited on the role of antiretroviral drug combinations. Therefore, we sought to investigate CVD risk associated with antiretroviral drug combinations. Methods Using an administrative health-plan dataset, risk of acute myocardial infarction (AMI) associated with current exposure to antiretroviral drug combinations was assessed among persons living with HIV receiving antiretroviral therapy (ART) across the U.S. from October 2009 through December 2014. To account for confounding-by-indication and for factors simultaneously acting as causal mediators and confounders, we applied inverse probability of treatment weighted marginal structural models to longitudinal data of patients. Results Over 114,417 person-years (n = 73,071 persons) of ART exposure, 602 cases of AMI occurred at an event rate of 5.26 (95% CI: 4.86, 5.70)/1000 person-years. Of the 14 antiretroviral drug combinations studied, persons taking abacavir-lamivudine-darunavir had the highest incidence rate (IR: 11/1000; 95% CI: 7.4-16.0) of AMI. Risk (HR; 95% CI) of AMI was elevated for current exposure to abacavir-lamivudine-darunavir (1.91; 1.27-2.88), abacavir-lamivudine-atazanavir (1.58; 1.08-2.31), and tenofovir-emtricitabine-raltegravir (1.35; 1.07-1.71). Tenofovir-emtricitabine-efavirenz was associated with reduced risk (0.65; 0.54-0.78). Abacavir-lamivudine-darunavir was associated with increased risk of AMI beyond that expected of abacavir alone, likely attributable to darunavir co-administration. We did not find an elevated risk of AMI when abacavir-lamivudine was combined with efavirenz or raltegravir. Conclusion The antiretroviral drug combinations abacavir-lamivudine-darunavir, abacavir-lamivudine-atazanavir and tenofovir-emtricitabine-raltegravir were found to be associated with elevated risk of AMI, while tenofovir-emtricitabine-efavirenz was associated with a lower risk. The AMI risk associated with abacavir-lamivudine-darunavir was greater than what was previously described for abacavir, which could suggest an added risk from darunavir. The results should be confirmed in additional studies.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available