title: Atazanavir is not associated with an increased risk of cardio- or cerebrovascular disease events.
abstract: OBJECTIVE
  To investigate whether there is any association between exposure to atazanavir (ATV), either when boosted or unboosted by ritonavir, and myocardial infarction (MI) or stroke within the D:A:D: Study.
  
  
  METHODS
  Prospective cohort collaboration.
  
  
  METHODS
  Poisson regression was used to investigate the association between cumulative exposure to ATV and MI/stroke risk after adjusting for known demographic and clinical confounders, as well as cumulative and recent exposure to specific antiretroviral drugs. Follow-up started on enrolment in the study and ended at the earliest of: a new MI/stroke event, death, 6 months after last clinic visit, or 1 February 2011.
  
  
  RESULTS
  The incidence of MI varied from 0.28 [95% confidence interval (CI) 0.26-0.30)]/100 person-years of follow-up (PYFU) in those with no exposure to ATV to 0.20 (0.12-0.32)/100 PYFU in those with more than 3 years exposure. There was no evidence of an association between cumulative exposure to ATV and MI risk, either in univariate [relative rate/year 0.96 (95% CI 0.88-1.04)] or multivariable [0.95 (0.87-1.05)] analyses. The incidence of stroke was 0.17 (0.16-0.19)/100 PYFU in those with no exposure to ATV and 0.17 (0.10-0.27)/100 PYFU in those with more than 3 years exposure. As with the MI endpoint, there was no evidence of an association with ATV exposure in either univariate [1.02 (0.98-1.05)] or multivariable [0.95 (0.87-1.05)] analyses.
  
  
  CONCLUSIONS
  These results argue against a class-wide association between exposure to HIV protease inhibitors and the risk of cardio/cerebrovascular events.
authors.affiliation: Hospital San Paolo, University of Milan, Italy.
authors.forename: Antonella d'Arminio
authors.initials: Ad
authors.lastname: Monforte
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Lene
authors.initials: L
authors.lastname: Ryom
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: Signe W
authors.initials: SW
authors.lastname: Worm
authors.forename: Mathew G
authors.initials: MG
authors.lastname: Law
authors.forename: Rainer
authors.initials: R
authors.lastname: Weber
authors.forename: Ole
authors.initials: O
authors.lastname: Kirk
authors.forename: Christian
authors.initials: C
authors.lastname: Pradier
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Phillips
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Sabin
mesh_terms: D000328:Adult; D000368:Aged; D000069446:Atazanavir Sulfate; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D009842:Oligopeptides / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D011725:Pyridines / Q000008:administration & dosage* / Q000009:adverse effects; D012307:Risk Factors; D019438:Ritonavir / Q000008:administration & dosage* / Q000009:adverse effects; D020521:Stroke / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D019562:Viral Load
chemical_list: D017320:HIV Protease Inhibitors; D009842:Oligopeptides; D011725:Pyridines; D000069446:Atazanavir Sulfate; D019438:Ritonavir