Table 2 |.
Effect of antiretroviral therapy on the risk of cardiovascular disease
| Study (year) | Study population | ART | Number of patients | Follow-up | Cardiovascular end points | Findings | Refs |
|---|---|---|---|---|---|---|---|
| Bozzette et al. (2003) | Patients with HIV infection who received care at a VA centre | Combination therapy with PIs, nucleoside analogues and NNRTIs | 36,766 | 8.5 years | CVD and cerebrovascular disease | Use of ART was associated with a reduction in the risk of CVD | 180 |
| D:A:D study group (2003) | Patients with HIV infection | Combination regimen including a PI or an NNRTI | 23,468 | 2.2 years | MI | Use of ART was associated with a 26% relative increase in rate of MI per year of exposure | 181 |
| SMART (2006) | Patients with well-controlled HIV infection; cohort from 33 countries | Continuous ART versus episodic use of ART | 5,472 | 16 months | Opportunistic disease or death from any cause; major cardiovascular, renal or hepatic disease | Continuous ART reduced the risk of CVD compared with episodic use of ART | 182 |
| D:A:D study group (2007) | Patients with HIV infection | PIs or NNRTIs | 23,437 | 5.2 years | MI | Exposure to PIs was associated with a higher rate of MI per year of exposure | 25 |
| D:A:D study group (2008) | Patients with HIV infection | NRTIs | 33,347 | 7.2 years | MI | Use of abacavir or didanosine in the previous 6 months was associated with increased risk of MI | 28 |
| Stein et al. (2015) | Patients with HIV infection without known CVD or diabetes mellitus who were initiating their first ART | NRTI, PI or integrase inhibitor | 328 | 6.4 years | Changes in carotid artery IMT | Atazanavir had a protective effect, with slower carotid IMT progression in the setting of high plasma bilirubin levels compared with other ART regimens | 183 |
| START (2015) | Patients with HIV infection; cohort from 35 countries | Immediate initiation of ART versus deferred initiation of ART | 4,299 | 6.4 years | MI, stroke, coronary revascularization or CVD-related death | Early initiation of ART did not significantly reduce the incidence of the cardiovascular end point | 184 |
| Marconi et al. (2018) | Individuals with or without HIV infection and without known CVD | NRTI, PI or NNRTI | 96,381 | 8.8 years | CVD including acute MI, heart failure and stroke | Decreased risk of CVD in the setting of high plasma bilirubin levels irrespective of HIV infection status | 120 |
| Elion et al. (2018) | Patients with HIV infection | NRTI | 8,265 | 12 years | Type 1 and type 2 MI | Use of abacavir in the past 6 months was associated with increased risk of MI | 31 |
| D:A:D study group (2018) | Patients with HIV | PIs | 49,709 | >15 years | CVD | Use of ritonavir-boosted darunavir but not ritonavir-boosted atazanavir was associated with increased risk of CVD | 27 |
ART, antiretroviral therapy ; CVD, cardiovascular disease; IMT, intima–media thickness; MI, myocardial infarction; NNRTI, non-nucleoside reverse-transcriptase inhibitor; NRTI, nucleoside reverse-transcriptase inhibitor; PI, protease inhibitor ; VA , Veterans Affairs.