Five antiretroviral combinations associated with increased risk of cardiovascular event
Treatment with four or five combinations of anti-HIV drugs is associated with an increased risk of a cardiovascular event, US researchers reported in the online edition of Clinic- Infectious Diseases.
But the authors point out that the absolute risk of an event was low and suggest “the primary consideration when choosing ART [antiretroviral therapy], the therapeutic regimen should be administered taking into account its effectiveness for HIV and organic tolerability.
In situations where equally effective therapeutic regimens are available, physicians should consider the potential increased risk of cardiovascular events, particularly in patients who are older or who have cardiovascular risk factors ".
The life expectancy of many people with HIV is basically normal now (translator's note: dir would 70 years or more). However, cardiovascular disease is a major cause of serious illness and death in people with HIV. The reasons for this are not yet fully understood. Traditional risk factors are thought to play an important role, as well as the inflammatory effects of HIV infection. But anti-HIV agents, especially abacavir and protease inhibitors, have been associated with an increased risk of a cardiovascular event in some studies.
Anti-HIV therapy consists of treatment with a combination of at least three antiretroviral drugs. Therefore, it is important to know whether certain drug combinations can increase the risk of cardiovascular7eg.
To answer that question, the researchers designed a study involving 24.510 people with HIV enrolled in veterans, whose records showed that they received combination antiretroviral therapy between 1996 and 2009.
"We chose to evaluate the most effective drug combinations because the drugs are always used in combination," explain the authors. “It is possible that combinations of drugs may increase risks cardiovascular8es in a way that could not be discovered by evaluating only individual drugs, or by evaluating the classes of drugs, as previous studies have done. ”
Fifteen specific drugs and 23 combinations were considered in the researchers' analysis. Integrase inhibitors and the newest non-analogue nucleotide reverse transcriptase inhibitors (NRTIs) were not included, but more old drugs, such as indinavir, nelfinavir and the ritonavir full-dose, were included.
Study participants had an average starting age of 47 years. Almost half (47%) had a history of smoking and 12% had evidence of diabetes. Although less than 1% of individuals have experienced an event cardiovascular9 at baseline, about 18% took statins for a year or more. The authors believe that the high prevalence of risk factors cardiovascular10 made this population particularly suitable for examining the association between different antiretroviral drugs and combinations and risk of events cardiovascular11es - heart attack, stroke, percutaneous coronary intervention (angioplasty) and myocardial revascularization surgery.
During the 16,4-year follow-up, 934 people had an event cardiovascular12.
The study looked at the relationship between current exposure of drug combinations at the time of an event rather than cumulative exposure.
Current treatment with four individual drugs was associated with this result:
- Lamivudine (OR = 1,53; 95% CI 1,34 -1.75)
- To Abacavir (OR = 1,50; 95% CI 1,26 -1,79)
- Efavirenz (OR = 1,40; 95% CI 1,19 -1.66)
- Zidovudine (OR = 1,41; 95% CI, 1.22-1 -63)
Current therapy with five therapeutic regimens has also been associated with increased risk of an event cardiovascular13 .
- Abacavir / lamivudine / atazanavir (OR = 2,08; 95% CI 1,41 -3.06)
- Zidovudine / lamivudine / atazanavir (OR = 2,04; 95% CI 1,37 -3,02)
- Abacavir / lamivudine / efavirenz (OR = 1,94; 95% CI 1,34 -2.79)
- Zidovudine / lamivudine / efavirenz (OR = 1,60; 95% CI 1,25 -2,04)
- Zidovudine / abacavir / lamivudine (OR = 1,60; 95% CI 1,21 -2,11).
The authors emphasize that their analyzes were designed to take into account competing risk factors. The results were similar in a secondary analysis, involving therapies of four and two combinations of drugs.
“Our study is the first to assess the association between antiretroviral drug combinations and risk of events cardiovascular14es “, comment the researchers. "Five combinations were implicated by our primary analysis."
But the researchers call for caution in interpreting their results.
“To provide some context for our results, we found that the absolute risk of events cardiovascular15for our cohort is twice that of a population with risk factors cardiovascular16 (approximately 4% versus 1,8%). The absolute risk, however, is still low. We suggest doctors interpret our findings in light of the relatively low absolute risk of events cardiovascular17es “.
Note from the publisher of Seropositive Web Site: It is important, in our part, as important actors in our survival, in view of these results, seek to minimize these risks cardiovascular18With exercises, even if simple and independent of a gym. There is an application, for IOS and ANDROID called CARDIOTRAINER, which makes the walking activity quite interesting! If you release the software to spend the battery and connect to a satellite it measures the distance you walked and how much has risen topographically speaking. It states, in a simplistic way, that in the exercise you have consumed, for example, the equivalent of two cherries or four apples. It's a cool way for you to compete with yourself, your biggest rival and I came on a walk of 25KM in three and a half hours, in which there was an elevation of twenty-five meters!
There is the challenge.
I want to see the picture of a walk less than this because, between us, ordinary mortals, I feel "The best "
Of course my proposal, though valid, is just one example. You can buy a bag of sand, has resources for it, put a picture of HIV and sit at beating the sandbag; care he responds yes!
Power must be balanced, light, rich in fibers etc.,
And who need spare vitamins and can not pay because the price is absurd, I point out this site (and you will purchase for your purchase risk) which is this link (Remember to consult your doctor about what u need to reset). The price is right and you will quickly conclude that rogue here care, they put their seals and sell with 400% profit. Do not automedique, ask your doctor to do a search (a blood test) to find out what you need and really need to reset. Remember that, according to the wise Drausio Dr. Varella, the Human body is designed to move and so we have so many "hinges". Binds and sends bullet
Published on: 08 May 2015
Translated from English, in the original in http://www.aidsmap.com/Five-antiretroviral-combinations-associated-with-increased-risk-of-a-cardiovascular19-event / page / 2964927 / by Cláudio Santos de Souza. I kindly request that you, the reader, if you have found any error or typing, or even a typo, that you contact from this link
Desai M. et al. Risk of cardiovascular20 Events associated with current exposure to HIV antiretroviral therapies in a US veteran population. Clin Infect Dis, online edition, 2015.