对于艾滋病毒感染者的心血管事件的初级预防,他类药物:目标试验和建模研究
Henock G Yebyo1, Huldrych F Guenthard2,3, Eva A Rehfuess4,5
1Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland.
BMJ medicine
|May 21, 2025
概括
类药物减少了艾滋病毒感染者的心血管疾病事件,但增加了2型糖尿病的风险. 益处与危害的平衡有利于对10年心血管疾病风险至少为13.8%的个人使用他类药物.
科学领域:
- 心脏病学 心脏病学
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
背景情况:
- 心血管疾病 (CVD) 是艾滋病毒感染者死亡的主要原因.
- 类药物广泛用于初级心血管疾病预防,但它们在艾滋病毒感染者中的益处危害概况需要进行具体评估.
研究的目的:
- 评估他类药物治疗对艾滋病毒感染者的初级心血管疾病预防的有效性和益处危害平衡.
- 为了确定在这个人群中启动他类药物治疗的最佳10年心血管疾病风险值.
主要方法:
- 一项针对性试验和建模研究,利用1995年至2019年北美艾滋病队列协作研究和设计 (NA-ACCORD) 的数据.
- 对54165名符合条件的40至75岁艾滋病毒感染者进行分析,将他类药物发起者与非发起者进行比较.
主要成果:
- 开始服用他类药物的患者心血管疾病事件减少了21%,中风/心肌梗塞风险减少了26%.
- 在使用他类药物时,观察到2型糖尿病风险增加了12%;对认知障碍,肌肉病和狂肠分裂的影响并不显著.
- 对于10年基线心血管疾病风险≥13.8%的个人来说,他类药物的益处超过了危害,子组之间存在差异.
结论:
- 对于中度至高心血管疾病风险的艾滋病毒感染者来说,他类药物提供了净益处,但启动门因子组和个人偏好而异.
- 个性化风险评估和共享决策对于为艾滋病毒感染者量身定制他类药物治疗至关重要.
- 需要进行进一步的受控研究来证实他类药物在当代抗逆转录病毒治疗中对艾滋病毒感染者的疗效和安全性.
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