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Initial antiretroviral therapy regimen and risk of heart failure.
Silverberg, Michael J; Pimentel, Noel; Leyden, Wendy A; Leong, Thomas K; Reynolds, Kristi; Ambrosy, Andrew P; Towner, William J; Hechter, Rulin C; Horberg, Michael; Vupputuri, Suma; Harrison, Teresa N; Lea, Alexandra N; Sung, Sue Hee; Go, Alan S; Neugebauer, Romain.
Afiliação
  • Silverberg MJ; Division of Research, Kaiser Permanente Northern California, Oakland.
  • Pimentel N; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena.
  • Leyden WA; Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco.
  • Leong TK; Division of Research, Kaiser Permanente Northern California, Oakland.
  • Reynolds K; Division of Research, Kaiser Permanente Northern California, Oakland.
  • Ambrosy AP; Division of Research, Kaiser Permanente Northern California, Oakland.
  • Towner WJ; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena.
  • Hechter RC; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena.
  • Horberg M; Division of Research, Kaiser Permanente Northern California, Oakland.
  • Vupputuri S; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena.
  • Harrison TN; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco.
  • Lea AN; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena.
  • Sung SH; Department of Infectious Diseases, Kaiser Permanente Los Angeles Medical Center, Los Angeles.
  • Go AS; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.
  • Neugebauer R; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena.
AIDS ; 38(4): 547-556, 2024 Mar 15.
Article em En | MEDLINE | ID: mdl-37967231
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.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Didesoxiadenosina / Infecções por HIV / Inibidores da Protease de HIV / Fármacos Anti-HIV / Ciclopropanos / Insuficiência Cardíaca Idioma: En Revista: AIDS Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Didesoxiadenosina / Infecções por HIV / Inibidores da Protease de HIV / Fármacos Anti-HIV / Ciclopropanos / Insuficiência Cardíaca Idioma: En Revista: AIDS Ano de publicação: 2024 Tipo de documento: Article