Table 1.
Assessment of clinical cardiovascular disease (CVD) risk in HIV-infected adults in association with protease inhibitors (PIs) as a class and as individual PIs
| Citation | Study | No. of HIV+ patients |
No. of HIV controls | CVD risk assessed | HR, PI use as a class | HR, PI use by individual drugs |
Description of study type |
| Ref 6 | Veterans Aging Study, Virtual Cohort | 27 168 | 55 109 | AMI | 1.34 (p=0.06) | Controlled for traditional CVD risk factors. |
|
| Ref 25 | Meta-analysis to 2010 | ACS and CVA risk/year. AMI risk/year. |
1.10 (1.05–1.17). 1.41 (1.20–1.65). |
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| Ref 26 | Meta-analysis, 11 studies | 2442 | ACS, AMI risk at 25.5 months | 2.68 (1.89–3.89) | |||
| Ref 22 | Veteran Affairs Quality Enhancement Research Initiative | 36 766 | AMI and CVA | 1.23 (0.78–1.93) (p=0.57) | Years 1993–2001, retrospective, 40 months f/u; 23.9% diabetes, HTN, ↑lipids, tobacco. |
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| Ref 23 | Veteran Ageing Cohort Study | 31 523 | 66 492 | Heart failure with ejection fraction | NS elevated versus no ART: PI: 1.80 (1.19–2.75). NNRTI: 1.48 (1.01–2.15). |
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| Ref 11 | D:A:D | 23 437 | AMI/1000 person-years | No PI: 1.00 >6years: 1.10. | Adjusted for lipids. | ||
| Ref 28 | D:A:D | ATV: 9611. ATV/r: 37 005. |
AMI/overall risk/year. CVA/overall risk/year. |
ATV: 0.80 (0.61–1.03); ATV/r: 0.99 (0.90–1.08) NS. ATV: 0.80 (0.61–1.03); ATV/r: 1.02 (0.98–1.06) NS. |
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| Ref 30 | D:A:D | 35 711 | CVD IRR/5 years | IDV 1.47; LPV/r 1.54. DRV/r 1.53 (1.28–1.84). ATV/r 1.0 (0.88–1.16) NS. |
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| Ref 18 | French Hospital Database | 289 | 884 | AMI/overall risk/year | 1.53 (1.21–1.94) | Amprenavir/LPV/r fosamprenavir±/r 1.56 (1.21–2.01). LPV/r: 1.34 (1.09–1.64). IDV: NS. SQV/r: NS. |
|
| Ref 17 | Meta-analysis | Eight studies to 2011 | AMI/overall risk/year | 2.13 (1.06–4.28) | ↑Relative risk/year of exposure: IDV/r: 1.11 (1.05–1.17). LPV/r: 1.22 (1.01–1.47). |
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| Ref 24 | RAMQ | 7053 | 27 681 | AMI/overall risk/year | LPV: 1.98 (1.24–3.16). RTV: 2.29 (1.48–3.51). |
HRs are statistically significant unless otherwise indicated.
Antiretroviral drug abbreviations: ATV, atazanavir; DRV, darunavir; IDV, indinavir; LPV, lopinavir; RTV, ritonavir; SQV, saquinavir; r: ritonavir-boosted protease inhibitor.
ACS, acute coronary syndrome; AMI, acute myocardial infarction; ART, antiretroviral therapy, CVA, cerebrovascular accident; D:A:D, Data Collection on Adverse Events of Anti-HIV Drugs; f/u, follw up; HTN, hypertension; IRR, incident rate ratio; NNRTI, non-nucleoside reverse transcriptase inhibitor; NS, not significant; RAMQ, Regie de l’assurance-maladie du Quebec.