abacavir and Acute-Disease

There is ongoing controversy regarding abacavir use in the treatment of HIV infection and the risk of subsequent development of cardiovascular disease. It is unclear how the risk varies as exposure accumulates.. Using an administrative health-plan dataset, risk of cardiovascular disease events (CVDe), defined as the first episode of an acute myocardial infarction or a coronary intervention procedure, associated with abacavir exposure was assessed among HIV-infected individuals receiving antiretroviral therapy across the U.S. from October 2009 through December 2014. The data were longitudinal, and analyzed using marginal structural models.. Over 114,470 person-years (n = 72,733) of ART exposure, 714 CVDe occurred at an incidence rate (IR) (95% CI) of 6·23 (5·80, 6·71)/1000 person-years. Individuals exposed to abacavir had a higher IR of CVDe of 9·74 (8·24, 11·52)/1000 person-years as compared to 5·75 (5·30, 6·24)/1000 person-years for those exposed to other antiretroviral agents. The hazard (HR; 95% CI) of CVDe was increased for current (1·43; 1·18, 1·73), recent (1·41; 1·16, 1·70), and cumulative [(1·18; 1·06, 1·31) per year] exposure to abacavir. The risk for cumulative exposure followed a bell-shaped dose-response curve peaking at 24-months of exposure. Risk was similarly elevated among participants free of pre-existing heart disease or history of illicit substance use at baseline.. Current, recent, and cumulative use of abacavir was associated with an increased risk of CVDe. The findings were consistent irrespective of underlying cardiovascular risk factors.

Topics: Acute Disease; Adult; Anti-Retroviral Agents; Cohort Studies; Databases, Factual; Dideoxynucleosides; Female; HIV Infections; Humans; Longitudinal Studies; Male; Middle Aged; Myocardial Infarction; Proportional Hazards Models; Reverse Transcriptase Inhibitors; Risk Factors; United States

Topics: Acute Disease; Anti-HIV Agents; Dideoxynucleosides; HIV Infections; HIV-1; Humans; Male; Middle Aged; Respiratory Hypersensitivity; Reverse Transcriptase Inhibitors

Influenza is a major cause of morbidity for people with significant underlying disease, but the impact of influenza on people infected with human immunodeficiency virus (HIV) remains unclear. We studied a population of HIV-infected adults during the 1998-1999 influenza season to see whether influenza had any adverse effects on the course of HIV infection. During 5 months of follow-up, we found no unique clinical manifestations or negative impact on CD4(+) cell count, virus load, or clinical progression of HIV disease. Although half of our cohort received antibiotic therapy, none received specific anti-influenza therapy and none required hospitalization. Acute influenza does not appear to be a risk for progression of HIV disease.

Topics: Acute Disease; Adult; AIDS-Related Opportunistic Infections; Anti-HIV Agents; CD4 Lymphocyte Count; Dideoxynucleosides; Disease Outbreaks; Disease Progression; Female; Humans; Influenza Vaccines; Influenza, Human; Male; Middle Aged; Reverse Transcriptase Inhibitors

Topics: Acquired Immunodeficiency Syndrome; Acute Disease; Anti-HIV Agents; Carbamates; Coronary Disease; Dideoxynucleosides; Drug Therapy, Combination; Furans; Hepatitis B; HIV Protease Inhibitors; Humans; Hyperlipoproteinemias; Male; Middle Aged; Pancreatitis; Risk Factors; Ritonavir; Sulfonamides