Consistent use of lipid lowering therapy in HIV infection is associated with low mortality
| Autor: | Roger Bedimo, James B Cutrell, Colby Ayers, Reuben J. Arasaratnam, Henning Drechsler |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Risk medicine.medical_specialty Statin medicine.drug_class Population Marginal structural model HIV Infections 030204 cardiovascular system & hematology lcsh:Infectious and parasitic diseases HIV Long-Term Survivors 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans lcsh:RC109-216 030212 general & internal medicine education Hypolipidemic Agents Veterans Aspirin education.field_of_study business.industry Confounding Hazard ratio Middle Aged Confidence interval United States Infectious Diseases Cohort Female business medicine.drug Research Article |
| Zdroj: | BMC Infectious Diseases BMC Infectious Diseases, Vol 21, Iss 1, Pp 1-10 (2021) |
| ISSN: | 1471-2334 |
| Popis: | Abstract Background In people living with HIV (PLWH), statins may be disproportionately effective but remain underutilized. A large prospective trial in patients with low to moderate cardiovascular (ASCVD) risk will reveal whether they should be considered in all PLWH. But its effect size may not apply to real-world PLWH with higher ASCVD and mortality risk. Also, the clinical role of non-statin lipid-lowering therapy (LLT) and LLT adherence in this population is unknown. Methods Comparative multi-level marginal structural model for all-cause mortality examining four time-updated exposure levels to LLT, antihypertensives, and aspirin in a virtual cohort of older PLWH. Incident coronary, cerebrovascular, and overall ASCVD events, serious infections, and new cancer diagnoses served as explanatory outcomes. Results In 23,276 HIV-infected US-veterans who were followed for a median of 5.2 years after virologic suppression overall mortality was 33/1000 patient years: > 3 times higher than in the US population. Use of antihypertensives or aspirin was associated with increased mortality. Past LLT use (> 1 year ago) had no effect on mortality. LLT exposure in the past year was associated with a reduced hazard ratio (HR) of death: 0.59, 95% confidence interval (CI) 0.51–0.69, p p = 0.03 for statin-free LLT. For consistent LLT use (> 11/12 past months) the HR of death was 0.48 (CI: 0.35–0.66) for statin-only LLT, 0.34 (CI: 0.23–0.52) for combination LLT, and 0.27 (CI: 0.15–0.48) for statin-free LLT (p Conclusions In PLWH, ongoing LLT use may lead to substantially lower mortality, but consistent long-term adherence may be required to reduce ASCVD risk. Consistent non-statin LLT may be highly effective and should be studied prospectively. |
| Databáze: | OpenAIRE |
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