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

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

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.

Author Information

aHospital San Paolo, University of Milan, Italy

bAcademic Medical Center, Amsterdam, The Netherlands

cCopenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark

dColumbia University/Harlem Hospital, New York, USA

eINSERM, Centre INSERM U897 ‘Epidémiologie et Biostatistique’

fUniversité Bordeaux Segalen, Institut de Santé Publique Epidémiologie Développement (ISPED), Bordeaux, France

gCHU Saint-Pierre Hospital, Department of Infectious Diseases, Brussels, Belgium

hKirby Institute, University of New South Wales, Sydney, Australia

iDivision of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland

jCHU Nice Hopital de l’Archet, Nice, France

kResearch Department of Infection and Population Health, UCL, London, UK.

Correspondence to Professor Caroline Sabin, Research Department of Infection and Population Health, UCL, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. Tel: +44 207 794 0500 ext. 34752; e-mail:

Received 4 September, 2012

Revised 2 October, 2012

Accepted 8 October, 2012

© 2013 Lippincott Williams & Wilkins, Inc.