Hypertension Risk with Abacavir Use among HIV-Infected Individuals: A Nationwide Cohort Study
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: A high risk of cardiovascular disease (CVD) is reported for HIV-infected individuals. While a link between abacavir and CVD risk is suggested, an association between abacavir and hypertension remains unclear. This study evaluated hypertension risk with abacavir use in comparison to non-abacavir antiretroviral treatment (ART). Materials and Methods: From a nationwide cohort of HIV-infected individuals on their initial ART, 6493 who were free of hypertensionat baseline were analyzed. The use of ART was treated as a time-varying covariate measured as a daily unit. Incidence rate of hypertension was calculated, and Cox proportional hazard models were used to estimate adjusted hazard ratios (HRs) with 95% confidence interval (CI) of incident hypertension overall and among subgroups. Results: From the 6493 participants, 24072 person-years (PY) of follow-up were contributed during 2008–2016. The incidence rates of hypertension were 4.6 and 3.6 per 100 PY for abacavir and non-abacavir ART users, respectively. The population attributablefraction of abacavir use on hypertension was 12%. Abacavir exposure did not elevate the risk of hypertension among overall study population [HR, 1.2 (95% CI, 1.0–1.4), p=0.061]. However, those with poor ART adherence, defined as a medication possessionratio <50% [HR, 1.9 (95% CI, 1.5–2.4), p<0.0001] or requiring prophylactic antibiotics [HR, 1.2 (95% CI, 1.0–1.3), p=0.023], were at risk of hypertension induced by abacavir, as were men, individuals aged ≥40 years, and patients visiting tertiary hospitals in urban areas. Conclusion: When present, poor ART adherence, requiring prophylactic antibiotics, male sex, and older age may warrant additionalconcern for hypertension in patients treated with abacavir.
Abstract
Purpose: A high risk of cardiovascular disease (CVD) is reported for HIV-infected individuals. While a link between abacavir and CVD risk is suggested, an association between abacavir and hypertension remains unclear. This study evaluated hypertension risk with abacavir use in comparison to non-abacavir antiretroviral treatment (ART). Materials and Methods: From a nationwide cohort of HIV-infected individuals on their initial ART, 6493 who were free of hypertensionat baseline were analyzed. The use of ART was treated as a time-varying covariate measured as a daily unit. Incidence rate of hypertension was calculated, and Cox proportional hazard models were used to estimate adjusted hazard ratios (HRs) with 95% confidence interval (CI) of incident hypertension overall and among subgroups. Results: From the 6493 participants, 24072 person-years (PY) of follow-up were contributed during 2008–2016. The incidence rates of hypertension were 4.6 and 3.6 per 100 PY for abacavir and non-abacavir ART users, respectively. The population attributablefraction of abacavir use on hypertension was 12%. Abacavir exposure did not elevate the risk of hypertension among overall study population [HR, 1.2 (95% CI, 1.0–1.4), p=0.061]. However, those with poor ART adherence, defined as a medication possessionratio <50% [HR, 1.9 (95% CI, 1.5–2.4), p<0.0001] or requiring prophylactic antibiotics [HR, 1.2 (95% CI, 1.0–1.3), p=0.023], were at risk of hypertension induced by abacavir, as were men, individuals aged ≥40 years, and patients visiting tertiary hospitals in urban areas. Conclusion: When present, poor ART adherence, requiring prophylactic antibiotics, male sex, and older age may warrant additionalconcern for hypertension in patients treated with abacavir.
참고문헌 (40)
- Calò LA, "Arterial hypertension and cardiovascular risk in HIV-infected patients", J Cardiovasc Med(Hagerstown), 14, pp.553~558 (2013)
- Armah KA, "Prehypertension, hypertension, and the risk of acute myocardial infarction in HIV-infected and -uninfected veterans", Clin Infect Dis, 58, pp.121~129 (2014)
- Nduka CU, "Evidence of increased blood pressure and hypertension risk among people living with HIV on antiretroviral therapy : a systematic review with meta-analysis", J Hum Hypertens, 30, pp.355~362 (2016)
- D : A : D Study Group, "Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D : A : D study : a multi-cohort collaboration", Lancet, 371, pp.1417~1426 (2008)
- Martin A, "Abacavir does not affect circulating levels of inflammatory or coagulopathic biomarkers in suppressed HIV : a randomized clinical trial", AIDS, 24, pp.2657~2663 (2010)
- Martínez E, "Abacavir-based therapy does not affect biological mechanisms associated with cardiovascular dysfunction", AIDS, 24, pp.F1~F9 (2010)
- Wohl DA, "Comparison of cardiovascular disease risk markers in HIV-infected patients receiving abacavir and tenofovir: the nucleoside inflammation, coagulation and endothelial function (NICE) study", Antivir Ther, 19, pp.141~147 (2014)
- Bavinger C, "Risk of cardiovascular disease from antiretroviral therapy for HIV: a systematic review", PLoS One, 8, pp.e59551~ (2013)
- Hatleberg CI, "Impact of antiretroviral drugs on hypertension in HIV-positive persons: D:A:D study", Conference of Retroviruses and Opportunistic Infections (CROI) (2015)
- Kim J, "Comparison of the prescribing pattern of bisphosphonate and raloxifene in Korean women with osteoporosis: from a national health insurance claims database", PLoS One, 10, pp.e0127970~ (2015)
- Choi HJ, "Risk of fractures in subjects with antihypertensive medications: a nationwide claim study", Int J Cardiol, 184, pp.62~67 (2015)
- Park JH, "Antihypertensive drug medication adherence and its affecting factors in South Korea", Int J Cardiol, 128, pp.392~398 (2008)
- Kim J, "Adherence to antiretroviral therapy and factors affecting low medication adherence among incident HIV-infected individuals during 2009-2016 : a nationwide study", Sci Rep, 8, pp.3133~ (2018)
- Choi AI, "Cardiovascular risks associated with abacavir and tenofovir exposure in HIV-infected persons", AIDS, 25, pp.1289~1298 (2011)
- Wong C, "First occurrence of diabetes, chronic kidney disease, and hypertension among North American HIV-infected adults, 2000-2013", Clin Infect Dis, 64, pp.459~467 (2017)
- Schneider E, "Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years— United States, 2008", MMWR Recomm Rep, 57, pp.1~12 (2008)
- Ryom L, "Association between cardiovascular disease and contemporarily used protease inhibitors", Conference on Retroviruses and Opportunistic Infections (CROI) (2017)
- van Zoest RA, "Higher prevalence of hypertension in HIV1-infected patients on combination antiretroviral therapy is associated with changes in body composition and prior stavudine exposure", Clin Infect Dis, 63, pp.205~213 (2016)
- Zapata-Diomedi B, "Population attributable fraction: names, types and issues with incorrect interpretation of relative risks", Br J Sports Med, 52, pp.212~213 (2018)
- Rockhill B, "Use and misuse of population attributable fractions", Am J Public Health, 88, pp.15~19 (1998)
- 이장훈, "Incidence of Hypertension in Korea: 5-Year Follow-up Study", Journal of Korean Medical Science, 26(10), pp.1286~1292 (2011), 대한의학회
- Okeke NL, "Hypertension among HIV-infected patients in clinical care, 1996-2013", Clin Infect Dis, 63, pp.242~248 (2016)
- Lackland DT, "Racial differences in hypertension : implications for high blood pressure management", Am J Med Sci, 348, pp.135~138 (2014)
- Rodríguez-Arbolí E, "Incidence and risk factors for hypertension among HIV patients in rural Tanzania-a prospective cohort study", PLoS One, 12, pp.e0172089~ (2017)
- Njelekela M, "Prevalence of hypertension and its associated risk factors among 34,111 HAART naïve HIV-infected adults in Dar es Salaam, Tanzania", Int J Hypertens, 2016, pp.5958382~ (2016)
- Pirani N, "Population attributable fraction for cardiovascular diseases risk factors in selected countries : a comparative study", Mater Sociomed, 29, pp.35~39 (2017)
- 오동현, "Metabolic Complications among Korean Patients with HIV Infection: The Korea HIV", AIDS Cohort Study, 2017, pp.32(8), 1268~1274[DOI]
- DAD Study Group, "Class of antiretroviral drugs and the risk of myocardial infarction", N Engl J Med, 356, pp.1723~1735 (2007)
- Hui DY, "Effects of HIV protease inhibitor therapy on lipid metabolism", Prog Lipid Res, 42, pp.81~92 (2003)
- McIntosh RC, "A meta-analysis of HIV and heart rate variability in the era of antiretroviral therapy", Clin Auton Res, 26, pp.287~294 (2016)
- Robinson-Papp J, "Autonomic dysfunction is common in HIV and associated with distal symmetric polyneuropathy", J Neurovirol, 19, pp.172~180 (2013)
- Dorjee K, "Risk of cardiovascu lar events from current, recent, and cumulative exposure to abacavir among persons living with HIV who were receiving antiretroviral therapy in the United States: a cohort study", BMC Infect Dis, 17, pp.708~ (2017)
- Marcus JL, "Use of abacavir and risk of cardiovascular disease among HIV-infected individuals", J Acquir Immune Defic Syndr, 71, pp.413~419 (2016)
- Sabin CA, "Is there continued evidence for an association between abacavir usage and myocardial infarction risk in individuals with HIV? A cohort collaboration", BMC Med, 14, pp.61~ (2016)
- McGoldrick C, "The management of dyslipidaemias in antiretroviral-treated HIV infection : a systematic review", HIV Med, 8, pp.325~334 (2007)
- Suissa S, "Immortal time bias in pharmaco-epidemiology", Am J Epidemiol, 167, pp.492~499 (2008)
- Lang S, "Impact of individual antiretroviral drugs on the risk of myocardial infarction in human immunodeficiency virus-infected patients : a case-control study nested within the French Hospital Database on HIV ANRS cohort CO4", Arch Intern Med, 170, pp.1228~1238 (2010)
- Young J, "Effect of cumulating exposure to abacavir on the risk of cardiovascular disease events in patients from the Swiss HIV cohort study", J Acquir Immune Defic Syndr, 69, pp.413~421 (2015)
- Bedimo RJ, "Abacavir use and risk of acute myocardial infarction and cerebrovascular events in the highly active antiretroviral therapy era", Clin Infect Dis, 53, pp.84~91 (2011)
- "The Report of HIV/AIDS"[URL]