학술논문
Initial antiretroviral therapy regimen and risk of heart failure.
Document Type
Academic Journal
Author
Silverberg MJ; Division of Research, Kaiser Permanente Northern California, Oakland.; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena.; Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco.; Pimentel N; Division of Research, Kaiser Permanente Northern California, Oakland.; Leyden WA; Division of Research, Kaiser Permanente Northern California, Oakland.; Leong TK; Division of Research, Kaiser Permanente Northern California, Oakland.; Reynolds K; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena.; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena.; Ambrosy AP; Division of Research, Kaiser Permanente Northern California, Oakland.; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena.; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco.; Towner WJ; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena.; Department of Infectious Diseases, Kaiser Permanente Los Angeles Medical Center, Los Angeles.; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.; Hechter RC; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena.; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena.; Horberg M; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena.; Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, MD.; Vupputuri S; Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, MD.; Harrison TN; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena.; Lea AN; Division of Research, Kaiser Permanente Northern California, Oakland.; Sung SH; Division of Research, Kaiser Permanente Northern California, Oakland.; Go AS; Division of Research, Kaiser Permanente Northern California, Oakland.; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena.; Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco.; Departments of Medicine, Health Research and Policy, Stanford University, Palo Alto, CA, USA.; Neugebauer R; Division of Research, Kaiser Permanente Northern California, Oakland.; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena.
Source
Publisher: Lippincott Williams & Wilkins Country of Publication: England NLM ID: 8710219 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1473-5571 (Electronic) Linking ISSN: 02699370 NLM ISO Abbreviation: AIDS Subsets: MEDLINE
Subject
Language
English
Abstract
Objectives: Heart failure risk is elevated in people with HIV (PWH). We investigated whether initial antiretroviral therapy (ART) regimens influenced heart failure risk.
Design: Cohort study.
Methods: PWH who initiated an ART regimen between 2000 and 2016 were identified from three integrated healthcare systems. We evaluated heart failure risk by protease inhibitor, nonnucleoside reverse transcriptase inhibitors (NNRTI), and integrase strand transfer inhibitor (INSTI)-based ART, and comparing two common nucleotide reverse transcriptase inhibitors: tenofovir disoproxil fumarate (tenofovir) and abacavir. Follow-up for each pairwise comparison varied (i.e. 7 years for protease inhibitor vs. NNRTI; 5 years for tenofovir vs. abacavir; 2 years for INSTIs vs. PIs or NNRTIs). Hazard ratios were from working logistic marginal structural models, fitted with inverse probability weighting to adjust for demographics, and traditional cardiovascular risk factors.
Results: Thirteen thousand six hundred and thirty-four PWH were included (88% men, median 40 years of age; 34% non-Hispanic white, 24% non-Hispanic black, and 24% Hispanic). The hazard ratio (95% CI) were: 2.5 (1.5-4.3) for protease inhibitor vs. NNRTI-based ART (reference); 0.5 (0.2-1.8) for protease inhibitor vs. INSTI-based ART (reference); 0.1 (0.1-0.8) for NNRTI vs. INSTI-based ART (reference); and 1.7 (0.5-5.7) for tenofovir vs. abacavir (reference). In more complex models of cumulative incidence that accounted for possible nonproportional hazards over time, the only remaining finding was evidence of a higher risk of heart failure for protease inhibitor compared with NNRTI-based regimens (1.8 vs. 0.8%; P = 0.002).
Conclusion: PWH initiating protease inhibitors may be at higher risk of heart failure compared with those initiating NNRTIs. Future studies with longer follow-up with INSTI-based and other specific ART are warranted.
(Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Design: Cohort study.
Methods: PWH who initiated an ART regimen between 2000 and 2016 were identified from three integrated healthcare systems. We evaluated heart failure risk by protease inhibitor, nonnucleoside reverse transcriptase inhibitors (NNRTI), and integrase strand transfer inhibitor (INSTI)-based ART, and comparing two common nucleotide reverse transcriptase inhibitors: tenofovir disoproxil fumarate (tenofovir) and abacavir. Follow-up for each pairwise comparison varied (i.e. 7 years for protease inhibitor vs. NNRTI; 5 years for tenofovir vs. abacavir; 2 years for INSTIs vs. PIs or NNRTIs). Hazard ratios were from working logistic marginal structural models, fitted with inverse probability weighting to adjust for demographics, and traditional cardiovascular risk factors.
Results: Thirteen thousand six hundred and thirty-four PWH were included (88% men, median 40 years of age; 34% non-Hispanic white, 24% non-Hispanic black, and 24% Hispanic). The hazard ratio (95% CI) were: 2.5 (1.5-4.3) for protease inhibitor vs. NNRTI-based ART (reference); 0.5 (0.2-1.8) for protease inhibitor vs. INSTI-based ART (reference); 0.1 (0.1-0.8) for NNRTI vs. INSTI-based ART (reference); and 1.7 (0.5-5.7) for tenofovir vs. abacavir (reference). In more complex models of cumulative incidence that accounted for possible nonproportional hazards over time, the only remaining finding was evidence of a higher risk of heart failure for protease inhibitor compared with NNRTI-based regimens (1.8 vs. 0.8%; P = 0.002).
Conclusion: PWH initiating protease inhibitors may be at higher risk of heart failure compared with those initiating NNRTIs. Future studies with longer follow-up with INSTI-based and other specific ART are warranted.
(Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)