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Cardiovascular outcomes among HIV-infected veterans receiving atazanavir.

Cardiovascular outcomes among HIV-infected veterans receiving atazanavir.
Author Information (click to view)

LaFleur J, Bress AP, Rosenblatt L, Crook J, Sax PE, Myers J, Ritchings C,


LaFleur J, Bress AP, Rosenblatt L, Crook J, Sax PE, Myers J, Ritchings C, (click to view)

LaFleur J, Bress AP, Rosenblatt L, Crook J, Sax PE, Myers J, Ritchings C,

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AIDS (London, England) 31(15) 2095-2106 doi 10.1097/QAD.0000000000001594

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 (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.

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