Impact of individual antiretroviral drugs on the risk of myocardial infarction in human immunodeficiency virus-infected patients: a case-control study nested within the French Hospital Database on HIV ANRS cohort CO4.
BACKGROUND
The role of exposure to specific antiretroviral drugs on risk of myocardial infarction in human immunodeficiency virus (HIV)-infected patients is debated in the literature.


METHODS
To assess whether we confirmed the association between exposure to abacavir and risk of myocardial infarction (MI) and to estimate the impact of exposure to other nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs), and non-NRTIs on risk of MI, we conducted a case-control study nested within the French Hospital Database on HIV. Cases (n = 289) were patients who, between January 2000 and December 2006, had a prospectively recorded first definite or probable MI. Up to 5 controls (n = 884), matched for age, sex, and clinical center, were selected at random with replacement among patients with no history of MI already enrolled in the database when MI was diagnosed in the corresponding case. Conditional logistic regression models were used to adjust for potential confounders.


RESULTS
Short-term/recent exposure to abacavir was associated with an increased risk of MI in the overall sample (odds ratios [ORs], 2.01; 95% confidence interval [CI], 1.11-3.64) but not in the subset of matched cases and controls (81%) who did not use cocaine or intravenous drugs (1.27; 0.64-2.49). Cumulative exposure to all PIs except saquinavir was associated with an increased risk of MI significant for amprenavir/fosamprenavir with or without ritonavir (OR, 1.53; 95% CI, 1.21-1.94 per year) and lopinavir with ritonavir (1.33; 1.09-1.61 per year). Exposure to all non-NRTIs was not associated with risk of MI.


CONCLUSIONS
The risk of MI was increased by cumulative exposure to all the studied PIs except saquinavir and particularly to amprenavir/fosamprenavir with or without ritonavir and lopinavir with ritonavir, whereas the association with abacavir cannot be considered causal.
Lang
Sylvie
S
INSERM Unité 943, 56 Boulevard V Auriol, Paris CEDEX 13, France.
Mary-Krause
Murielle
M
Cotte
Laurent
L
Gilquin
Jacques
J
Partisani
Marialuisa
M
Simon
Anne
A
Boccara
Franck
F
Costagliola
Dominique
D
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002219:Carbamates / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D015331:Cohort Studies; D016001:Confidence Intervals; D015224:Dideoxynucleosides / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005602:France / Q000453:epidemiology; D005663:Furans; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy*; D055819:Hospitals, Isolation / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D016017:Odds Ratio; D010755:Organophosphates / Q000008:administration & dosage / Q000009:adverse effects*; D012044:Regression Analysis; D012306:Risk; D019438:Ritonavir / Q000008:administration & dosage / Q000009:adverse effects*; D013449:Sulfonamides / Q000008:administration & dosage / Q000009:adverse effects*; D000099227:Abacavir
D019380:Anti-HIV Agents; D002219:Carbamates; D015224:Dideoxynucleosides; D005663:Furans; D010755:Organophosphates; D019438:Ritonavir; D013449:Sulfonamides; D000099227:Abacavir; C095108:amprenavir; C426859:fosamprenavir