Cited by 1,521HIV-related health complications and treatmentsHIV/AIDS drug development and treatmentLipoproteins and Cardiovascular Health

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Class of Antiretroviral Drugs and the Risk of Myocardial Infarction

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The DAD Study Group·2007·New England Journal of Medicine

DOI 10.1056/nejmoa062744

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Abstract

BACKGROUND: We have previously demonstrated an association between combination antiretroviral therapy and the risk of myocardial infarction. It is not clear whether this association differs according to the class of antiretroviral drugs. We conducted a study to investigate the association of cumulative exposure to protease inhibitors and nonnucleoside reverse-transcriptase inhibitors with the risk of myocardial infarction. METHODS: We analyzed data collected through February 2005 from our prospective observational study of 23,437 patients infected with the human immunodeficiency virus. The incidence rates of myocardial infarction during the follow-up period were calculated, and the associations between myocardial infarction and exposure to protease inhibitors or nonnucleoside reverse-transcriptase inhibitors were determined. RESULTS: Three hundred forty-five patients had a myocardial infarction during 94,469 person-years of observation. The incidence of myocardial infarction increased from 1.53 per 1000 person-years in those not exposed to protease inhibitors to 6.01 per 1000 person-years in those exposed to protease inhibitors for more than 6 years. After adjustment for exposure to the other drug class and established cardiovascular risk factors (excluding lipid levels), the relative rate of myocardial infarction per year of protease-inhibitor exposure was 1.16 (95% confidence interval [CI], 1.10 to 1.23), whereas the relative rate per year of exposure to nonnucleoside reverse-transcriptase inhibitors was 1.05 (95% CI, 0.98 to 1.13). Adjustment for serum lipid levels further reduced the effect of exposure to each drug class to 1.10 (95% CI, 1.04 to 1.18) and 1.00 (95% CI, 0.93 to 1.09), respectively. CONCLUSIONS: Increased exposure to protease inhibitors is associated with an increased risk of myocardial infarction, which is partly explained by dyslipidemia. We found no evidence of such an association for nonnucleoside reverse-transcriptase inhibitors; however, the number of person-years of observation for exposure to this class of drug was less than that for exposure to protease inhibitors.

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10.1210/jc.74.5.1045 · DOI
Phillips AN, Carr A, Neuhaus J, et al. Interruption of ART and risk of cardiovascular disease: findings from SMART. Presented at the 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles, February 26, 2007. abstract. (Accessed March 29, 2007, athttp://www.retroconference.org/2007/abstracts/28863.htm.)
Sabin C, Morfeldt L, Friis-Møller N, et al. Changes over time in antiretroviral therapy (ART) use and risk factors for cardiovascular disease (CVD) in the D:A:D study. Presented at the 12th Conference on Retroviruses and Opportunistic Infections, Boston, February 25, 2005. abstract. (Accessed March 29, 2007, athttp://www.retroconference.org/2005/cd/abstracts/25243.htm.)

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Authors: The DAD Study Group
Corresponding author: The DAD Study Group
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2007-04-26
Volume: 356
Issue: 17
Pages: 1723-1735
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa062744
OpenAlex: W1767400858
Cited by: 1,521
References: 26
Citations by year: 2026: 17 · 2025: 22 · 2024: 19 · 2023: 30 · 2022: 30 · 2021: 45 · 2020: 39 · 2019: 49 · 2018: 64 · 2017: 51 · 2016: 81 · 2015: 92 · 2014: 87 · 2013: 114 · 2012: 130
FWCI: 185.17
Type: journal article
Language: en
Open access: green
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
Digital Access to Libraries (submittedVersion)
Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
UCL Discovery (University College London) (submittedVersion)
Pure Amsterdam UMC (submittedVersion)
Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
Columbia Academic Commons (Columbia University)
Funders: National Institute of Allergy and Infectious Diseases (U01AI046362, U01AI042170)
Topics: Health Sciences › Medicine › Infectious Diseases › HIV-related health complications and treatments
Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
Keywords: myocardial infarction, antiretroviral drugs, protease inhibitors, non-nucleoside reverse transcriptase inhibitors, HIV infection, cardiovascular risk, dyslipidemia, serum lipids, drug exposure duration
MeSH terms: Adult, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction, Prospective Studies, Risk, HIV-1, HIV Infections, Incidence, Poisson Distribution, HIV Protease Inhibitors, Reverse Transcriptase Inhibitors, Observation, Anti-Retroviral Agents, Dyslipidemias

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Class of Antiretroviral Drugs and the Risk of Myocardial Infarction

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