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AIDS:
doi: 10.1097/QAD.0b013e32835b2ef1
Clinical Science: Concise Communications

Atazanavir is not associated with an increased risk of cardio or cerebrovascular disease events

Monforte, Antonella d’Arminioa; Reiss, Peterb; Ryom, Lenec; El-Sadr, Wafaad; Dabis, Francoise,f; De Wit, Stephaneg; Worm, Signe W.c; Law, Mathew G.h; Weber, Raineri; Kirk, Olec; Pradier, Christianj; Phillips, Andrew N.k; Lundgren, Jens D.c; Sabin, Caroline A.k

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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.

Design: 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.

Conclusion: These results argue against a class-wide association between exposure to HIV protease inhibitors and the risk of cardio/cerebrovascular events.

© 2013 Lippincott Williams & Wilkins, Inc.

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