@article{9b32d94b591542d4a4fa170792119ee9,
title = "Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration.",
abstract = "BACKGROUND: Whether nucleoside reverse transcriptase inhibitors increase the risk of myocardial infarction in HIV-infected individuals is unclear. Our aim was to explore whether exposure to such drugs was associated with an excess risk of myocardial infarction in a large, prospective observational cohort of HIV-infected patients. METHODS: We used Poisson regression models to quantify the relation between cumulative, recent (currently or within the preceding 6 months), and past use of zidovudine, didanosine, stavudine, lamivudine, and abacavir and development of myocardial infarction in 33 347 patients enrolled in the D:A:D study. We adjusted for cardiovascular risk factors that are unlikely to be affected by antiretroviral therapy, cohort, calendar year, and use of other antiretrovirals. FINDINGS: Over 157,912 person-years, 517 patients had a myocardial infarction. We found no associations between the rate of myocardial infarction and cumulative or recent use of zidovudine, stavudine, or lamivudine. By contrast, recent-but not cumulative-use of abacavir or didanosine was associated with an increased rate of myocardial infarction (compared with those with no recent use of the drugs, relative rate 1.90, 95% CI 1.47-2.45 [p=0.0001] with abacavir and 1.49, 1.14-1.95 [p=0.003] with didanosine); rates were not significantly increased in those who stopped these drugs more than 6 months previously compared with those who had never received these drugs. After adjustment for predicted 10-year risk of coronary heart disease, recent use of both didanosine and abacavir remained associated with increased rates of myocardial infarction (1.49, 1.14-1.95 [p=0.004] with didanosine; 1.89, 1.47-2.45 [p=0.0001] with abacavir). INTERPRETATION: There exists an increased risk of myocardial infarction in patients exposed to abacavir and didanosine within the preceding 6 months. The excess risk does not seem to be explained by underlying established cardiovascular risk factors and was not present beyond 6 months after drug cessation.",
keywords = "Adult, Aged, Aged, 80 and over, Didanosine, Dideoxynucleosides, Female, HIV Infections, Humans, Male, Middle Aged, Myocardial Infarction, Poisson Distribution, Reverse Transcriptase Inhibitors, Risk Factors",
author = "NN NN and Sabin, {Caroline A} and Worm, {Signe W} and Rainer Weber and Peter Reiss and Wafaa El-Sadr and Francois Dabis and {De Wit}, Stephane and Matthew Law and {D'Arminio Monforte}, Antonella and Nina Friis-M{\o}ller and Ole Kirk and Christian Pradier and Ian Weller and Phillips, {Andrew N} and Lundgren, {Jens D}",
note = "Multicenterunders{\o}gelse",
year = "2008",
doi = "10.1016/S0140-6736(08)60423-7",
language = "English",
volume = "371",
pages = "1417--26",
journal = "Lancet",
issn = "1474-547X",
publisher = "Elsevier BV",
number = "9622",
}