Risk of cardiovascular events from current, recent, and cumulative exposure to abacavir among persons living with HIV who were receiving antiretroviral therapy in the United States: a cohort study

BMC Infectious Diseases

Research Article

Arthur L. Reingold¹  Sanjiv M. Baxi²  Alan Hubbard³  Kunchok Dorjee⁴ 

[1] Division of Epidemiology, School of Public Health, University of California Berkeley, Hall Berkeley, 94720-7358, 101 Haviland, CA, USA;Division of Epidemiology, School of Public Health, University of California Berkeley, Hall Berkeley, 94720-7358, 101 Haviland, CA, USA;Department of Medicine, University of California San Francisco, San Francisco, California, USA;Division of Epidemiology, School of Public Health, University of California Berkeley, Hall Berkeley, 94720-7358, 101 Haviland, CA, USA;Division of Biostatistics, School of Public Health, University of California Berkeley, Berkeley, California, USA;Division of Epidemiology, School of Public Health, University of California Berkeley, Hall Berkeley, 94720-7358, 101 Haviland, CA, USA;Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA;

关键词: HIV;    Abacavir;    Anti-retroviral therapy;    Cardiovascular disease;   

DOI  :  10.1186/s12879-017-2808-8

 received in 2017-07-11, accepted in 2017-10-23,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThere is ongoing controversy regarding abacavir use in the treatment of HIV infection and the risk of subsequent development of cardiovascular disease. It is unclear how the risk varies as exposure accumulates.MethodsUsing an administrative health-plan dataset, risk of cardiovascular disease events (CVDe), defined as the first episode of an acute myocardial infarction or a coronary intervention procedure, associated with abacavir exposure was assessed among HIV-infected individuals receiving antiretroviral therapy across the U.S. from October 2009 through December 2014. The data were longitudinal, and analyzed using marginal structural models.ResultsOver 114,470 person-years (n = 72,733) of ART exposure, 714 CVDe occurred at an incidence rate (IR) (95% CI) of 6·23 (5·80, 6·71)/1000 person-years. Individuals exposed to abacavir had a higher IR of CVDe of 9·74 (8·24, 11·52)/1000 person-years as compared to 5·75 (5·30, 6·24)/1000 person-years for those exposed to other antiretroviral agents. The hazard (HR; 95% CI) of CVDe was increased for current (1·43; 1·18, 1·73), recent (1·41; 1·16, 1·70), and cumulative [(1·18; 1·06, 1·31) per year] exposure to abacavir. The risk for cumulative exposure followed a bell-shaped dose-response curve peaking at 24-months of exposure. Risk was similarly elevated among participants free of pre-existing heart disease or history of illicit substance use at baseline.ConclusionCurrent, recent, and cumulative use of abacavir was associated with an increased risk of CVDe. The findings were consistent irrespective of underlying cardiovascular risk factors.

【 授权许可】

CC BY   
© The Author(s). 2017