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.
authors.affiliation: Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark. sww@cphiv.dk <sww@cphiv.dk>
authors.forename: Signe Westring
authors.initials: SW
authors.lastname: Worm
authors.forename: Caroline
authors.initials: C
authors.lastname: Sabin
authors.forename: Rainer
authors.initials: R
authors.lastname: Weber
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Wafaa
authors.initials: W
authors.lastname: El-Sadr
authors.forename: Francois
authors.initials: F
authors.lastname: Dabis
authors.forename: Stephane
authors.initials: S
authors.lastname: De Wit
authors.forename: Matthew
authors.initials: M
authors.lastname: Law
authors.forename: Antonella D'Arminio
authors.initials: AD
authors.lastname: Monforte
authors.forename: Nina
authors.initials: N
authors.lastname: Friis-Møller
authors.forename: Ole
authors.initials: O
authors.lastname: Kirk
authors.forename: Eric
authors.initials: E
authors.lastname: Fontas
authors.forename: Ian
authors.initials: I
authors.lastname: Weller
authors.forename: Andrew
authors.initials: A
authors.lastname: Phillips
authors.forename: Jens
authors.initials: J
authors.lastname: Lundgren
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced / Q000209:etiology*; D016012:Poisson Distribution; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents