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
| Autor(a) principal: | |
|---|---|
| Data de Publicação: | 2017 |
| Outros Autores: | , , , , , , , |
| Tipo de documento: | Artigo |
| Idioma: | por |
| Título da fonte: | Repositório Institucional da FIOCRUZ (ARCA) |
| Texto Completo: | https://www.arca.fiocruz.br/handle/icict/25402 |
Resumo: | 2018-10-31 |
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Oliveira, Raquel de Vasconcellos Carvalhaes deShimakura, Silvia EmikoCampos, Dayse PereiraHökerberg, Yara Hahr MarquesVictoriano, Flaviana PavanRibeiro, SayonaraVeloso, Valdiléa G.Grinsztejn, BeatrizCarvalho, Marilia Sá2018-03-19T18:04:12Z2018-03-19T18:04:12Z2017OLIVEIRA, Raquel de Vasconcellos Carvalhaes de et al. 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. AIDS Care, p. 1-10, 2017.0954-0121https://www.arca.fiocruz.br/handle/icict/2540210.1080/09540121.2017.1391984porTaylor & FrancisEffects of antiretroviral treatment and nadir CD4 count in progression to cardiovascular events and related comorbidities in a HIV Brazilian cohort: a multi-stage approachinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article2018-10-31Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Universidade Federal do Paraná. Setor de Ciências Exatas. Curitiba, PR, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Presidência. Programa de Computação Científica. Rio de Janeiro, RJ, Brasil.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 (s1), arterial hypertension (s2), lipid abnormalities (s3), hypertension and lipid abnormalities (s4) and major cardiovascular events (stroke, coronary artery disease, thrombosis or death) (s5). 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/mm3), (HR = 1.59, CI 1.11-2.28 and 1.36, CI 1.11-1.66, respectively). The risk to experience a second comorbidity (s3→s4) 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 (s3,s4→s5). The prolonged use of certain antiretroviral drugs (abacavir, didanosine, ritonavir, lopinavir, amprenavir and fosamprenavir) increased the risk of direct transition (s1→s5) 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.Cardiovascular eventsProgressionHIVMulti-stage modelCohort studyAIDSCohort studyHIVAIDSinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; charset=utf-83099https://www.arca.fiocruz.br/bitstream/icict/25402/1/license.txt586c046dcfeef936e32f0323bb9a47c0MD51ORIGINALEffects of antiretroviral treatment and nadir CD4 count in progression to cardiovascular events and related comorbidities in a HIV Brazilian cohort a.pdfEffects of antiretroviral treatment and nadir CD4 count in progression to cardiovascular events and related comorbidities in a HIV Brazilian cohort 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| dc.title.pt_BR.fl_str_mv |
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 |
| title |
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 |
| spellingShingle |
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 Oliveira, Raquel de Vasconcellos Carvalhaes de Cardiovascular events Progression HIV Multi-stage model Cohort study AIDS Cohort study HIV AIDS |
| title_short |
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 |
| title_full |
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 |
| title_fullStr |
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 |
| title_full_unstemmed |
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 |
| title_sort |
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 |
| author |
Oliveira, Raquel de Vasconcellos Carvalhaes de |
| author_facet |
Oliveira, Raquel de Vasconcellos Carvalhaes de Shimakura, Silvia Emiko Campos, Dayse Pereira Hökerberg, Yara Hahr Marques Victoriano, Flaviana Pavan Ribeiro, Sayonara Veloso, Valdiléa G. Grinsztejn, Beatriz Carvalho, Marilia Sá |
| author_role |
author |
| author2 |
Shimakura, Silvia Emiko Campos, Dayse Pereira Hökerberg, Yara Hahr Marques Victoriano, Flaviana Pavan Ribeiro, Sayonara Veloso, Valdiléa G. Grinsztejn, Beatriz Carvalho, Marilia Sá |
| author2_role |
author author author author author author author author |
| dc.contributor.author.fl_str_mv |
Oliveira, Raquel de Vasconcellos Carvalhaes de Shimakura, Silvia Emiko Campos, Dayse Pereira Hökerberg, Yara Hahr Marques Victoriano, Flaviana Pavan Ribeiro, Sayonara Veloso, Valdiléa G. Grinsztejn, Beatriz Carvalho, Marilia Sá |
| dc.subject.en.pt_BR.fl_str_mv |
Cardiovascular events Progression HIV Multi-stage model Cohort study AIDS |
| topic |
Cardiovascular events Progression HIV Multi-stage model Cohort study AIDS Cohort study HIV AIDS |
| dc.subject.decs.pt_BR.fl_str_mv |
Cohort study HIV AIDS |
| description |
2018-10-31 |
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2017 |
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2017 |
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2018-03-19T18:04:12Z |
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2018-03-19T18:04:12Z |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
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article |
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OLIVEIRA, Raquel de Vasconcellos Carvalhaes de et al. 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. AIDS Care, p. 1-10, 2017. |
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https://www.arca.fiocruz.br/handle/icict/25402 |
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0954-0121 |
| dc.identifier.doi.none.fl_str_mv |
10.1080/09540121.2017.1391984 |
| identifier_str_mv |
OLIVEIRA, Raquel de Vasconcellos Carvalhaes de et al. 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. AIDS Care, p. 1-10, 2017. 0954-0121 10.1080/09540121.2017.1391984 |
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por |
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Taylor & Francis |
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Taylor & Francis |
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