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Risk of Myocardial Infarction in Patients with HIV Infection Exposed to Specific Individual Antiretroviral Drugs from the 3 Major Drug Classes: The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study

Worm, Signe Westring ; Sabin, Caroline ; Weber, Rainer ; Reiss, Peter ; El-Sadr, Wafaa ; Dabis, Francois ; De Wit, Stephane ; Law, Matthew ; Monforte, Antonella D'Arminio ; Friis-Møller, Nina ; Kirk, Ole ; Fontas, Eric ; Weller, Ian ; Phillips, Andrew ; Lundgren, Jens

In: The Journal of Infectious Diseases, 2010, vol. 201, no. 3, p. 318-330

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    Titre
    • Risk of Myocardial Infarction in Patients with HIV Infection Exposed to Specific Individual Antiretroviral Drugs from the 3 Major Drug Classes: The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study
    Auteur
    • Worm, Signe Westring. Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark
    • Sabin, Caroline. Research Department of Infection and Population Health University College London, London, United Kingdom
    • Weber, Rainer. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
    • Reiss, Peter. HIV Monitoring Foundation, Academic Medical Center, Amsterdam, the Netherlands
    • El-Sadr, Wafaa. Columbia University and Harlem Hospital, New York City, New York
    • Dabis, Francois. Institut National de la Santé et de la Recherche Médicale E0338 and U593, Institut de Santé Publique, d'Épidémiologie et de Développement, Université Victor Segalen, Bordeaux
    • De Wit, Stephane. Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre Hospital, Brussels, Belgium
    • Law, Matthew. National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia
    • Monforte, Antonella D'Arminio. Hospital San Paolo, University of Milan, Milan, Italy
    • Friis-Møller, Nina. Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark
    • Kirk, Ole. Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark
    • Fontas, Eric. Centre Hospitalier Universitaire Nice Hopital de l'Archet, Nice, France
    • Weller, Ian. Centre for Sexual Health and HIV Research, University College London, London, United Kingdom
    • Phillips, Andrew. Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark
    • Lundgren, Jens. Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • The Journal of Infectious Diseases, 2010, vol. 201, no. 3, p. 318-330. The University of Chicago Press
    Autre version électronique
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:291961
    Summary
    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