Objective: Patients with HIV infection have an increased risk of cardiovascular disease compared with uninfected individuals. Antiretroviral therapy with atazanavir delays progression of atherosclerosis markers; whether this reduces cardiovascular disease event risk compared with other antiretroviral regimens is currently unknown.
Design: Population-based, non-interventional, historical cohort study conducted from July 1, 2003, through December 31, 2015.
Setting: Veterans Health Administration (VHA) hospitals and clinics throughout the United States.
Participants: Treatment-naive patients with HIV infection (N = 9500).
Antiretroviral exposures: Initiating antiretroviral regimens containing atazanavir, other protease inhibitors (PIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), or integrase strand transfer inhibitors (INSTIs).
Main outcome/effect size measures: Incidence rates of myocardial infarction (MI), stroke, and all-cause mortality within each regimen. Atazanavir versus other PI, NNRTI, or INSTI covariate-adjusted hazard ratios using Cox proportional hazards models and inverse probability of treatment weighting (IPTW).
Results: Incidence rates for MI, stroke, and all-cause mortality with atazanavir-containing regimens (5.2, 10.4, and 16.0 per 1000 patient-years, respectively) were lower than with regimens containing other PIs (10.2, 21.9, and 23.3 per 1000 patient-years), NNRTIs (7.5, 15.9, and 17.5 per 1000 patient-years), or INSTIs (13.0, 33.1, and 21.5 per 1000 patient-years). After IPTW, adjusted hazard ratios (95% confidence intervals) for MI, stroke, and all-cause mortality with atazanavir-containing regimens versus all non-atazanavir-containing regimens were 0.59 (0.41-0.84), 0.64 (0.50-0.81), and 0.90 (0.73-1.11), respectively.
Conclusions: Among treatment-naive HIV-infected patients in the VHA initiating atazanavir-containing regimens, risk of both MI and stroke were significantly lower than in those initiating regimens containing other PIs, NNRTIs, or INSTIs.
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