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Cardiovascular Side Effects of HIV Treatment

Cardiovascular Side Effects of HIV Treatment. Jean-Guy Baril, MD Mark Wainberg, Phd. The D:A:D Cohort. What is D:A:D? The Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) A prospective multi-cohort study of HIV-1 positive persons under active follow up.

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Cardiovascular Side Effects of HIV Treatment

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  1. Cardiovascular Side Effects of HIV Treatment Jean-Guy Baril, MD Mark Wainberg, Phd

  2. The D:A:D Cohort • What is D:A:D? • The Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) • A prospective multi-cohort study of HIV-1 positive persons under active follow up. • D:A:D 1 – 23,441 patients enrolled 1999-2001 • D:A:D 2 – 12,900 patients enrolled through Spring 2004 • D:A:D 3 – 16,000 patients enrolled in 2010 • 11 cohorts worldwide • More than 49,000 patients from 212 clinics in 33 countries in Europe, USA and Australia. • Core Data: • Incident cases of cardiovascular disease in HIV infected persons • Other Data: • Risk factors for CVD including previous MI, stroke, family history, smoking status, diabetes, dyslipidemia, and hypertension • Investigate associations between these risk factors, stage of HIV disease and use of antiretroviral therapies • Non-AIDS defining malignancies • End-stage renal disease • Chronic liver disease • Death Source: http://www.cphiv.dk/dad/about/tabid/106/default.aspx

  3. MI incidence increases with longer exposure to combination antiretroviral therapy Adjusted relative rate, 1.16 per year of exposure; 95% confidence interval [CI],1.09 to 1.23 Myocardial Infarction Incidence per 1000 Person-year Source: Class of Antiretroviral Drugs and the Risk of Myocardial Infarction. Writing committee: N Friis-Moller et al.N Engl J Med. 2007 April 26;356:1723-35

  4. MI Risk and Drug Class Myocardial Infarction Adjusted Relative Rate Source: Class of Antiretroviral Drugs and the Risk of Myocardial Infarction. Writing committee: N Friis-Moller et al. N Engl J Med. 2007 April 26;356:1723-35

  5. Increased risk of myocardial infarction after cumulative exposure to HIV medications • Cumulative exposure (relative rate [RR] per additional year) • Indinavir 1.12 [95% CI, 1.07–1.18] • Lopinavir-ritonavir 1.13 [95% CI, 1.05–1.21] • Abacavir 1.07 [95% CI, 1.00–1.14] • Recent Exposure to • abacavir 1.70 [95% CI, 1.17–2.47] • didanosine RR,1.41 [95% CI, 1.09–1.82] Source: Risk of Myocardial Infarction in Patients with HIV Infection Exposed to Specific Individual Antiretroviral Drugs from the 3 Major Drug classes: The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study. Worm SW et al. J Infect Dis. 2010 Feb 1;201(3):318-30.

  6. FDA Meta-Analysis of CVD Risk from Abacavir Containing Regimens Source: Ding X., et al. No Association of Myocardial Infarction with ABC Use: An FDA Meta-analysis . CROI 2011 Paper #808

  7. D:A:D Risk for Current or Recent Exposure to Abacavir • Relative Rate • 1.70 [95% CI, 1.17–2.47] Source: Risk of Myocardial Infarction in Patients with HIV Infection Exposed to Specific Individual Antiretroviral Drugs from the 3 Major Drug classes: The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study. Worm SW et al. J Infect Dis. 2010 Feb 1;201(3):318-30.

  8. D:A:D Risk for Cumulative Exposure to Abacavir • Relative Rate of MI per Additional year • 1.07 [95% CI, 1.00–1.14] Source: Risk of Myocardial Infarction in Patients with HIV Infection Exposed to Specific Individual Antiretroviral Drugs from the 3 Major Drug classes: The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study. Worm SW et al. J Infect Dis. 2010 Feb 1;201(3):318-30.

  9. Abacavir Associated MI Risk in the Quebec Cohort Source: Durand M et al. Association between HIV infection, antiretroviral therapy, and risk of acute myocardial infarction: a cohort and nested case-control study using Québec's public health insurance database. J Acquir Immune Defic Syndr. 2011 Jul 1;57(3):245-53.

  10. Lack of CVD Risk with Atazanavir Source: Monforte A. d’A. et al. ATV-containing ART Is Not Associated with an Increased Risk of Cardio- or Cerebro-vascular Events in the D:A:D Study . CROI 2012 Paper #823

  11. No Effect from Ritonavir Boosting Source: Monforte A. d’A. et al. ATV-containing ART Is Not Associated with an Increased Risk of Cardio- or Cerebro-vascular Events in the D:A:D Study . CROI 2012 Paper #823

  12. Effect of Lopinavir on Lipid Levels Source: Montes ML, et al. Lipid disorders in antiretroviral-naive patients treated with lopinavir/ritonavir-based HAART: frequency, characterization and risk factors. J Antimicrob Chemother. 2005 May;55(5):800-4

  13. MI Risk with Protease Inhibitor Use • Unadjusted Relative Rate Per Year of Exposure • 1.16 (95% CI, 1.09 to 1.23) • Adjusted for Lipid Levels • 1.10 (95% CI, 1.04 to 1.18) Source: Class of Antiretroviral Drugs and the Risk of Myocardial Infarction. Writing committee: N Friis-Moller et al. N Engl J Med. 2007 April 26;356:1723-35

  14. Ole Kirk et al. 2010 Chronic Kidney Disease and Exposure to ART in a Large Cohort with Long-term Follow-up: The EuroSIDA Study Paper # 107LB

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