PMID- 28692532
DCOM- 20180514
LR  - 20180523
IS  - 1473-5571 (Electronic)
IS  - 0269-9370 (Linking)
VI  - 31
IP  - 15
DP  - 2017 Sep 24
TI  - Cardiovascular outcomes among HIV-infected veterans receiving atazanavir.
PG  - 2095-2106
LID - 10.1097/QAD.0000000000001594 [doi]
AB  - 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 (N =
      9500). 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.
FAU - LaFleur, Joanne
AU  - LaFleur J
AD  - 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.
FAU - Bress, Adam P
AU  - Bress AP
FAU - Rosenblatt, Lisa
AU  - Rosenblatt L
FAU - Crook, Jacob
AU  - Crook J
FAU - Sax, Paul E
AU  - Sax PE
FAU - Myers, Joel
AU  - Myers J
FAU - Ritchings, Corey
AU  - Ritchings C
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
JT  - AIDS (London, England)
JID - 8710219
RN  - 0 (HIV Protease Inhibitors)
RN  - 4MT4VIE29P (Atazanavir Sulfate)
SB  - IM
SB  - X
MH  - Adult
MH  - Aged
MH  - Atazanavir Sulfate/*therapeutic use
MH  - Cohort Studies
MH  - Female
MH  - HIV Infections/*complications/*drug therapy
MH  - HIV Protease Inhibitors/*therapeutic use
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*epidemiology
MH  - Risk Assessment
MH  - Stroke/*epidemiology
MH  - Treatment Outcome
MH  - United States/epidemiology
MH  - *Veterans
PMC - PMC5603981
EDAT- 2017/07/12 06:00
MHDA- 2018/05/15 06:00
CRDT- 2017/07/11 06:00
PHST- 2017/07/12 06:00 [pubmed]
PHST- 2018/05/15 06:00 [medline]
PHST- 2017/07/11 06:00 [entrez]
AID - 10.1097/QAD.0000000000001594 [doi]
PST - ppublish
SO  - AIDS. 2017 Sep 24;31(15):2095-2106. doi: 10.1097/QAD.0000000000001594.