دورية أكاديمية
أعرض في EDS

Effects of antiretroviral treatment and nadir CD4 count in progression to cardiovascular events and related comorbidities in a HIV Brazilian cohort: a multi-stage approach.

التفاصيل البيبلوغرافية
العنوان: Effects of antiretroviral treatment and nadir CD4 count in progression to cardiovascular events and related comorbidities in a HIV Brazilian cohort: a multi-stage approach.
المؤلفون: Oliveira RVC; a Instituto Nacional de Infectologia Evandro Chagas , Fundação Oswaldo Cruz , Rio de Janeiro , Brazil., Shimakura SE; b Setor de Ciências Exatas , Universidade Federal do Paraná , Curitiba , Brazil., Campos DP; a Instituto Nacional de Infectologia Evandro Chagas , Fundação Oswaldo Cruz , Rio de Janeiro , Brazil., Hökerberg YHM; a Instituto Nacional de Infectologia Evandro Chagas , Fundação Oswaldo Cruz , Rio de Janeiro , Brazil., Victoriano FP; a Instituto Nacional de Infectologia Evandro Chagas , Fundação Oswaldo Cruz , Rio de Janeiro , Brazil., Ribeiro S; a Instituto Nacional de Infectologia Evandro Chagas , Fundação Oswaldo Cruz , Rio de Janeiro , Brazil., Veloso VG; a Instituto Nacional de Infectologia Evandro Chagas , Fundação Oswaldo Cruz , Rio de Janeiro , Brazil., Grinsztejn B; a Instituto Nacional de Infectologia Evandro Chagas , Fundação Oswaldo Cruz , Rio de Janeiro , Brazil., Carvalho MS; c Programa de Computação Científica , Fundação Oswaldo Cruz , Rio de Janeiro , Brazil.
المصدر: AIDS care [AIDS Care] 2018 May; Vol. 30 (5), pp. 551-559. Date of Electronic Publication: 2017 Oct 23.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Informa Healthcare Country of Publication: England NLM ID: 8915313 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1360-0451 (Electronic) Linking ISSN: 09540121 NLM ISO Abbreviation: AIDS Care Subsets: MEDLINE
أسماء مطبوعة: Publication: London : Informa Healthcare
Original Publication: Abingdon, Oxfordshire, U.K. : Carfax Pub. Co., c1989-
مواضيع طبية MeSH: Anti-HIV Agents/*therapeutic use , Antiretroviral Therapy, Highly Active/*statistics & numerical data , Cardiovascular Diseases/*epidemiology , Dyslipidemias/*epidemiology , HIV Infections/*drug therapy , HIV Infections/*immunology, Adolescent ; Adult ; Age Factors ; Aged ; Brazil/epidemiology ; CD4 Lymphocyte Count ; Cardiovascular Diseases/mortality ; Cohort Studies ; Comorbidity ; Coronary Artery Disease/epidemiology ; Disease Progression ; Female ; Humans ; Hypertension/epidemiology ; Male ; Middle Aged ; Proportional Hazards Models ; Stroke/epidemiology ; Thrombosis/epidemiology ; Young Adult
مستخلص: The use of highly active antiretroviral therapy has resulted in changes of comorbidity profile in people living with HIV (PLHIV), increasing non-AIDS-related events. The occurrence of cardiovascular events is greater in PLHIV, but the mechanism responsible for it is still controversial. This article aimed to investigate factors associated with the progression to cardiovascular events in PLHIV using HAART. A 15-years cohort study with 1135 PLHIV was conducted in Rio de Janeiro-Brazil. Clinical progression was stratified in five states: No comorbidities (s 1 ), arterial hypertension (s 2 ), lipid abnormalities (s 3 ), hypertension and lipid abnormalities (s 4 ) and major cardiovascular events (stroke, coronary artery disease, thrombosis or death) (s 5 ). Semi-Markov models evaluated the effects of cardiovascular traditional factors, treatment and clinical covariates on transitions between these states. Hazard Ratios (HR) and 95% confidence intervals (CI) were provided. In addition to traditional factors (age, sex, educational level and skin color), the development of one comorbidity (lipid abnormalities or hypertension) increased in patients with low nadir CD4 (<50 cells/mm 3 ), (HR = 1.59, CI 1.11-2.28 and 1.36, CI 1.11-1.66, respectively). The risk to experience a second comorbidity (s 3 →s 4 ) increased 75% with low nadir CD4. Age was the only factor that increased the risk of major cardiovascular events once having lipid abnormalities with or without hypertension (s 3 ,s 4 →s 5 ). The prolonged use of certain antiretroviral drugs (abacavir, didanosine, ritonavir, lopinavir, amprenavir and fosamprenavir) increased the risk of direct transition (s 1 →s 5 ) to major cardiovascular events (HR = 5.29, CI 1.16-24.05). This analysis suggests that prolonged use of certain antiretroviral drugs led directly to major cardiovascular events, while low nadir CD4 only affected the occurrence of lipid abnormalities and hypertension. Management strategies, including rational use of complex exams (such as, computed-tomography angiography), statins and antihypertensives, should be developed based on the distinct roles of antiretroviral use and of HIV infection itself on the progression to cardiovascular events.
فهرسة مساهمة: Keywords: Cardiovascular events; HIV/AIDS; cohort study; multi-stage model; progression
المشرفين على المادة: 0 (Anti-HIV Agents)
تواريخ الأحداث: Date Created: 20171024 Date Completed: 20190528 Latest Revision: 20190528
رمز التحديث: 20240628
DOI: 10.1080/09540121.2017.1391984
PMID: 29058481
قاعدة البيانات: MEDLINE
الوصف
تدمد:1360-0451
DOI:10.1080/09540121.2017.1391984