Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes: the data collection on adverse events of anti-HIV drugs (D:A:D) study

Signe Westring Worm; Caroline Sabin; Rainer Weber; Peter Reiss; Wafaa El-Sadr; Francois Dabis; Stephane De Wit; Matthew Law; Antonella D'Arminio Monforte; Nina Friis-Møller; Ole Kirk; Eric Fontas; Ian Weller; Andrew Phillips; Jens Lundgren

doi:10.1086/649897

Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes: the data collection on adverse events of anti-HIV drugs (D:A:D) study

Signe Westring Worm, Caroline Sabin, Rainer Weber, Peter Reiss, Wafaa El-Sadr, Francois Dabis, Stephane De Wit, Matthew Law, Antonella D'Arminio Monforte, Nina Friis-Møller, Ole Kirk, Eric Fontas, Ian Weller, Andrew Phillips, Jens Lundgren

483 Citations (Scopus)

Abstract

Background. The risk of myocardial infarction (MI) in patients with human immunodeficiency virus (HIV) infection has been assessed in 13 anti-HIV drugs in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. Methods. Poisson regression models were adjusted for cardiovascular risk factors, cohort, calendar year, and use of other antiretroviral drugs and assessed the association between MI risk and cumulative (per year) or recent (current or in the past 6 months) use of antiretroviral drugs, with >30,000 person-years of exposure. Results. Over 178,835 person-years, 580 patients developed MI. There were no associations between use of tenofovir, zalcitabine, zidovudine, stavudine, or lamivudine and MI risk. Recent exposure to abacavir or didanosine was associated with an increased risk of MI. No association was found between MI risk and cumulative exposure to nevirapine, efavirenz, nelfinavir, or saquinavir. Cumulative exposure to indinavir and lopinavir-ritonavir was associated with an increased risk of MI (relative rate [RR] per year, 1.12 and 1.13, respectively). These increased risks were attenuated slightly (RR per year, 1.08 [95% confidence interval {CI}, 1.02-1.14] and 1.09 [95% CI, 1.01-1.17], respectively) after adjustment for lipids but were not altered further after adjustment for other metabolic parameters. Conclusions. Of the drugs considered, only indinavir, lopinavir-ritonavir, didanosine, and abacavir were associated with a significantly increased risk of MI. As with any observational study, our findings must be interpreted with caution (given the potential for confounding) and in the context of the benefits that these drugs provide.

Original language	English
Journal	Journal of Infectious Diseases
Volume	201
Issue number	3
Pages (from-to)	318-30
Number of pages	13
ISSN	0022-1899
DOIs	https://doi.org/10.1086/649897 https://doi.org/10.1086/649897
Publication status	Published - 1 Feb 2010

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Worm, S. W., Sabin, C., Weber, R., Reiss, P., El-Sadr, W., Dabis, F., De Wit, S., Law, M., Monforte, A. DA., Friis-Møller, N., Kirk, O., Fontas, E., Weller, I., Phillips, A., & Lundgren, J. (2010). Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes: the data collection on adverse events of anti-HIV drugs (D:A:D) study. Journal of Infectious Diseases, 201(3), 318-30. https://doi.org/10.1086/649897, https://doi.org/10.1086/649897

Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes: the data collection on adverse events of anti-HIV drugs (D:A:D) study. / Worm, Signe Westring; Sabin, Caroline; Weber, Rainer et al.

In: Journal of Infectious Diseases, Vol. 201, No. 3, 01.02.2010, p. 318-30.

Research output: Contribution to journal › Journal article › Research › peer-review

Worm, SW, Sabin, C, Weber, R, Reiss, P, El-Sadr, W, Dabis, F, De Wit, S, Law, M, Monforte, ADA, Friis-Møller, N, Kirk, O, Fontas, E, Weller, I, Phillips, A & Lundgren, J 2010, 'Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes: the data collection on adverse events of anti-HIV drugs (D:A:D) study', Journal of Infectious Diseases, vol. 201, no. 3, pp. 318-30. https://doi.org/10.1086/649897, https://doi.org/10.1086/649897

Worm SW, Sabin C, Weber R, Reiss P, El-Sadr W, Dabis F et al. Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes: the data collection on adverse events of anti-HIV drugs (D:A:D) study. Journal of Infectious Diseases. 2010 Feb 1;201(3):318-30. doi: 10.1086/649897, http://dx.doi.org/10.1086/649897

@article{a8694d007ec311df928f000ea68e967b,

title = "Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes: the data collection on adverse events of anti-HIV drugs (D:A:D) study",

abstract = "Background. The risk of myocardial infarction (MI) in patients with human immunodeficiency virus (HIV) infection has been assessed in 13 anti-HIV drugs in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. Methods. Poisson regression models were adjusted for cardiovascular risk factors, cohort, calendar year, and use of other antiretroviral drugs and assessed the association between MI risk and cumulative (per year) or recent (current or in the past 6 months) use of antiretroviral drugs, with >30,000 person-years of exposure. Results. Over 178,835 person-years, 580 patients developed MI. There were no associations between use of tenofovir, zalcitabine, zidovudine, stavudine, or lamivudine and MI risk. Recent exposure to abacavir or didanosine was associated with an increased risk of MI. No association was found between MI risk and cumulative exposure to nevirapine, efavirenz, nelfinavir, or saquinavir. Cumulative exposure to indinavir and lopinavir-ritonavir was associated with an increased risk of MI (relative rate [RR] per year, 1.12 and 1.13, respectively). These increased risks were attenuated slightly (RR per year, 1.08 [95% confidence interval {CI}, 1.02-1.14] and 1.09 [95% CI, 1.01-1.17], respectively) after adjustment for lipids but were not altered further after adjustment for other metabolic parameters. Conclusions. Of the drugs considered, only indinavir, lopinavir-ritonavir, didanosine, and abacavir were associated with a significantly increased risk of MI. As with any observational study, our findings must be interpreted with caution (given the potential for confounding) and in the context of the benefits that these drugs provide.",

author = "Worm, {Signe Westring} and Caroline Sabin and Rainer Weber and Peter Reiss and Wafaa El-Sadr and Francois Dabis and {De Wit}, Stephane and Matthew Law and Monforte, {Antonella D'Arminio} and Nina Friis-M{\o}ller and Ole Kirk and Eric Fontas and Ian Weller and Andrew Phillips and Jens Lundgren",

note = "Keywords: Adult; Aged; Anti-HIV Agents; Female; HIV Infections; Humans; Logistic Models; Male; Middle Aged; Myocardial Infarction; Poisson Distribution; Risk Factors",

year = "2010",

month = feb,

day = "1",

doi = "10.1086/649897",

language = "English",

volume = "201",

pages = "318--30",

journal = "Journal of Infectious Diseases",

issn = "0022-1899",

publisher = "Oxford University Press",

number = "3",

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TY - JOUR

T1 - Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes: the data collection on adverse events of anti-HIV drugs (D:A:D) study

AU - Worm, Signe Westring

AU - Sabin, Caroline

AU - Weber, Rainer

AU - Reiss, Peter

AU - El-Sadr, Wafaa

AU - Dabis, Francois

AU - De Wit, Stephane

AU - Law, Matthew

AU - Monforte, Antonella D'Arminio

AU - Friis-Møller, Nina

AU - Kirk, Ole

AU - Fontas, Eric

AU - Weller, Ian

AU - Phillips, Andrew

AU - Lundgren, Jens

N1 - Keywords: Adult; Aged; Anti-HIV Agents; Female; HIV Infections; Humans; Logistic Models; Male; Middle Aged; Myocardial Infarction; Poisson Distribution; Risk Factors

PY - 2010/2/1

Y1 - 2010/2/1

N2 - Background. The risk of myocardial infarction (MI) in patients with human immunodeficiency virus (HIV) infection has been assessed in 13 anti-HIV drugs in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. Methods. Poisson regression models were adjusted for cardiovascular risk factors, cohort, calendar year, and use of other antiretroviral drugs and assessed the association between MI risk and cumulative (per year) or recent (current or in the past 6 months) use of antiretroviral drugs, with >30,000 person-years of exposure. Results. Over 178,835 person-years, 580 patients developed MI. There were no associations between use of tenofovir, zalcitabine, zidovudine, stavudine, or lamivudine and MI risk. Recent exposure to abacavir or didanosine was associated with an increased risk of MI. No association was found between MI risk and cumulative exposure to nevirapine, efavirenz, nelfinavir, or saquinavir. Cumulative exposure to indinavir and lopinavir-ritonavir was associated with an increased risk of MI (relative rate [RR] per year, 1.12 and 1.13, respectively). These increased risks were attenuated slightly (RR per year, 1.08 [95% confidence interval {CI}, 1.02-1.14] and 1.09 [95% CI, 1.01-1.17], respectively) after adjustment for lipids but were not altered further after adjustment for other metabolic parameters. Conclusions. Of the drugs considered, only indinavir, lopinavir-ritonavir, didanosine, and abacavir were associated with a significantly increased risk of MI. As with any observational study, our findings must be interpreted with caution (given the potential for confounding) and in the context of the benefits that these drugs provide.

AB - Background. The risk of myocardial infarction (MI) in patients with human immunodeficiency virus (HIV) infection has been assessed in 13 anti-HIV drugs in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. Methods. Poisson regression models were adjusted for cardiovascular risk factors, cohort, calendar year, and use of other antiretroviral drugs and assessed the association between MI risk and cumulative (per year) or recent (current or in the past 6 months) use of antiretroviral drugs, with >30,000 person-years of exposure. Results. Over 178,835 person-years, 580 patients developed MI. There were no associations between use of tenofovir, zalcitabine, zidovudine, stavudine, or lamivudine and MI risk. Recent exposure to abacavir or didanosine was associated with an increased risk of MI. No association was found between MI risk and cumulative exposure to nevirapine, efavirenz, nelfinavir, or saquinavir. Cumulative exposure to indinavir and lopinavir-ritonavir was associated with an increased risk of MI (relative rate [RR] per year, 1.12 and 1.13, respectively). These increased risks were attenuated slightly (RR per year, 1.08 [95% confidence interval {CI}, 1.02-1.14] and 1.09 [95% CI, 1.01-1.17], respectively) after adjustment for lipids but were not altered further after adjustment for other metabolic parameters. Conclusions. Of the drugs considered, only indinavir, lopinavir-ritonavir, didanosine, and abacavir were associated with a significantly increased risk of MI. As with any observational study, our findings must be interpreted with caution (given the potential for confounding) and in the context of the benefits that these drugs provide.

U2 - 10.1086/649897

DO - 10.1086/649897

M3 - Journal article

SN - 0022-1899

VL - 201

SP - 318

EP - 330

JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

IS - 3

ER -