Clinical Topics   /   HIV

Atazanavir’s Effects on CV Risks in HIV Infected Veterans

By U.S. Medicine

SALT LAKE CITY—Patients with HIV infection have an increased risk of cardiovascular disease compared with uninfected individuals. Oftentimes, they receive antiretroviral therapy with atazanavir (ATV), which delays progression of atherosclerosis markers.

Whether the treatment also reduces cardiovascular disease event risk compared with other antiretroviral regimens is unknown, however, according to a study in the journal AIDS.1

Researchers from the Salt Lake City VAMC and other institutions conducted a population-based, noninterventional, historical cohort study conducted from July 1, 2003, through Dec. 31, 2015, to better understand the effects. The focus was on 9,500 treatment-naïve HIV-infected patients at VHA hospitals and clinics through the United States. Participants were initiating antiretroviral regimens containing ATV, other protease inhibitors, nonnucleoside reverse transcriptase inhibitors (NNRTIs) or integrase strand transfer inhibitors (INSTIs).

The study team analyzed incidence rates of myocardial infarction (MI), stroke and all-cause mortality within each regimen: ATV vs. other protease inhibitor, NNRTI, or INSTI.

Results indicated that incidence rates for MI, stroke and all-cause mortality with ATV-containing regimens (5.2, 10.4, and 16.0 per 1,000 patient-years, respectively) were lower than with regimens containing other protease inhibitors (10.2, 21.9, and 23.3 per 1,000 patient-years), NNRTIs (7.5, 15.9, and 17.5 per 1,000 patient-years) or INSTIs (13.0, 33.1, and 21.5 per 1,000 patient-years). 

After inverse probability of treatment-weighting, adjusted hazard ratios for MI, stroke and all-cause mortality with ATV-containing regimens vs. all non-ATV-containing regimens were 0.59 (0.41-0.84), 0.64 (0.50-0.81), and 0.90 (0.73-1.11), respectively.

“Among treatment-naive HIV-infected patients in the Veterans Health Administration initiating ATV-containing regimens, risk of both MI and stroke were significantly lower than in those initiating regimens containing other protease inhibitors, NNRTIs or INSTIs,” researchers concluded.

  1. LaFleur J, Bress AP, Rosenblatt L, Crook J, Sax PE, Myers J, Ritchings C. Cardiovascular outcomes among HIV-infected veterans receiving atazanavir. AIDS. 2017 Sep 24;31(15):2095-2106. doi: 10.1097/QAD.0000000000001594. PubMed PMID: 28692532; PubMed Central PMCID: PMC5603981.

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