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AIDS. 2017 Sep 24;31(15):2095-2106. doi: 10.1097/QAD.0000000000001594.

Cardiovascular outcomes among HIV-infected veterans receiving atazanavir.

Author information

1
aDepartment of Pharmacotherapy, University of Utah College of Pharmacy bInformatics, Decision-Enhancement, and Surveillance (IDEAS) Center, Salt Lake City VA Health Care System cDepartment of Population Health Sciences, University of Utah, Salt Lake City, Utah dBristol-Myers Squibb, Lawrenceville, New Jersey eDivision of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah fDepartment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.

Abstract

OBJECTIVE:

Patients with HIV infection have an increased risk of cardiovascular disease compared with uninfected individuals. Antiretroviral therapy with atazanavir (ATV) delays progression of atherosclerosis markers; whether this reduces cardiovascular disease event risk compared with other antiretroviral regimens is currently unknown.

DESIGN:

Population-based, noninterventional, historical cohort study conducted from 1 July 2003 through 31 December 2015.

SETTING:

Veterans Health Administration hospitals and clinics throughout the United States.

PARTICIPANTS:

Treatment-naive patients with HIV infection (Nā€Š=ā€Š9500).

ANTIRETROVIRAL EXPOSURES:

Initiating antiretroviral regimens containing ATV, other protease inhibitors, nonnucleoside reverse transcriptase inhibitors (NNRTIs), or integrase strand transfer inhibitors (INSTIs).

MAIN OUTCOME/EFFECT SIZE MEASURES:

Incidence rates of myocardial infarction (MI), stroke, and all-cause mortality within each regimen. ATV versus other protease inhibitor, NNRTI, or INSTI covariate-adjusted hazard ratios by using Cox proportional hazards models and inverse probability of treatment weighting.

RESULTS:

Incidence rates for MI, stroke, and all-cause mortality with ATV-containing regimens (5.2, 10.4, and 16.0 per 1000 patient-years, respectively) were lower than with regimens containing other protease inhibitors (10.2, 21.9, and 23.3 per 1000 patient-years), NNRTIs (7.5, 15.9, and 17.5 per 1000 patient-years), or INSTIs (13.0, 33.1, and 21.5 per 1000 patient-years). After inverse probability of treatment weighting, adjusted hazard ratios (95% confidence intervals) for MI, stroke, and all-cause mortality with ATV-containing regimens versus all non-ATV-containing regimens were 0.59 (0.41-0.84), 0.64 (0.50-0.81), and 0.90 (0.73-1.11), respectively.

CONCLUSION:

Among treatment-naive HIV-infected patients in the Veterans Health Administration initiating ATV-containing regimens, risk of both MI and stroke were significantly lower than in those initiating regimens containing other protease inhibitors, NNRTIs, or INSTIs.

PMID:
28692532
PMCID:
PMC5603981
DOI:
10.1097/QAD.0000000000001594
[Indexed for MEDLINE]
Free PMC Article

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