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Antiretrovirals Lower Risk of Heart Failure in HIV-Infected Veterans

by U.S. Medicine

May 30, 2017

SAN FRANCISCO – Despite higher risk of chronic kidney disease, most human immunodeficiency virus(HIV)-infected patients in the United States take the antiretroviral medication tenofovir disoproxil fumarate (TDF).

A study published in the Journal of the American Heart Association explored an association between the drug and incident heart (HF), for which chronic kidney disease. is a strong risk factor.

The study team led by San Francisco VAMC and University of California San Francisco researchers identified 21,435 human immunodeficiency virus-infected patients at the VHA actively using antiretrovirals between 2002 and 2011. Excluded were patients with a prior diagnosis of HF.

TDF was analyzed categorically (current, past, or never use) and continuously (per year of use) and adjustment were made for demographic, human immunodeficiency virus-related, and cardiovascular risk factors.

During follow-up, 438 incident HF events occurred. Results indicated that unadjusted five-year event rates for current, past, and never users of TDF were 0.9, 1.7 and 4.5, respectively.

In fully adjusted analyses, the researchers found that HF risk was significantly lower in current TDF users, HR=0.68, compared with never users. In fact, among current TDF users, the study pointed out that each additional year of TDF exposure was associated with a 21% lower risk of incident HF — 0.68-0.92.

Furthermore, when limited to antiretroviral-naive patients, HF risk remained lower in current TDF users, HR=0.53, compared to never users.

“Among a large national cohort of human immunodeficiency virus-infected patients, TDF use was strongly associated with lower risk of incident HF,” study authors concluded. “These findings warrant confirmation in other populations, both with TDF and the recently approved tenofovir alafenamide fumarate.”


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