Abacavir use and cardiovascular disease events

Cruciani, Mario; Zanichelli, Veronica; Serpelloni, Giovanni; Bosco, Oliviero; Malena, Marina; Mazzi, Romualdo; Mengoli, Carlo; Parisi, Saverio Giuseppe; Moyle, Graeme

doi:10.1097/qad.0b013e328349c6ee

Cited by 138 publications

(56 citation statements)

References 40 publications

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“…Solid organ transplantation has not previously been recognized as a risk factor. However, a systematic review concluded that liver transplant patients receiving antifungal prophylaxis exhibited a reduction of episodes caused by C. albicans but had a higher proportion of C. glabrata infections (7). In this single-center study, exposure to antibacterial agents was a protective factor for candidemia caused by non-albicans Candida spp.…”

Section: Discussionmentioning

confidence: 78%

Risk Factors for Fluconazole-Resistant Candidemia

Garnacho-Montero

Díaz-Martín

García-Cabrera

et al. 2010

Antimicrob Agents Chemother

102

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Bloodstream infections (BSIs) due to Candida species are a serious complication in hospitalized patients. Candidemia is associated with a high mortality rate and has obvious effects on resource use (11). Over the past few decades, the incidence of candidemia has increased markedly (2, 3). Moreover, the increment of candidemia caused by Candida species other than Candida albicans is a common finding in recent series (3, 12). These species include C. glabrata and C. krusei, which tend to be more resistant to fluconazole and therefore present a particular challenge for clinical management.Diverse studies highlight the importance of early and appropriate empirical therapy in invasive Candida infection (14, 21). Fluconazole is currently considered the initial therapy for most adult patients with candidemia (20). As the selection of empirical therapy is driven in large part by the likely epidemiology, there is a need to identify patients at risk of candidemia caused by species resistant to fluconazole in order to begin with adequate empirical antifungal therapy.In order to provide guidance to clinicians to initiate empirical treatment for candidemia, prior studies have addressed risk factors for candidemia caused by non-albicans Candida spp.(1, 9, 10, 23) or by potentially fluconazole-resistant organisms (Candida glabrata and Candida krusei) (16, 23, 28) but have not taken into consideration in vitro resistance to fluconazole. In these studies, prior fluconazole exposure was an independent risk factor for candidemia caused by non-albicans Candida species (1) or by potentially fluconazole-resistant species (23), whereas other studies did not find this association (16,28). Therefore, to the best of our knowledge, the risk factors for microbiologically proven fluconazole-resistant Candida spp. BSIs have not been comprehensively studied. We conducted the prospective single-center study described here to identify the variables associated with the diagnosis of fluconazole-resistant candidemia. Our working hypothesis was that fluconazole administration is an independent risk factor only in the emergence of BSIs caused by fluconazole-resistant Candida. MATERIALS AND METHODSHospital. The prospective study described here was carried out in the Virgen del Rocío University Hospital, a large urban hospital with teaching accreditation, from January 2004 to June 2009. The hospital has a solid organ (liver, heart, kidney) transplantation program and an active bone marrow transplantation

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Section: Discussionmentioning

confidence: 78%

Risk Factors for Fluconazole-Resistant Candidemia

Garnacho-Montero

Díaz-Martín

García-Cabrera

et al. 2010

Antimicrob Agents Chemother

102

View full text Add to dashboard Cite

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“…Some additional studies have confirmed the increased risk described in the D:A:D [10,18,44,49,[54][55][56]; however, other studies have not found evidence of such association [47,48,[57][58][59][60] (Table 2).…”

Section: Nucleoside Reverse Transcriptase Inhibitors (Nrti's)mentioning

confidence: 75%

“…Recently, two additional meta-analyses and an observational cohort of subjects randomized to ACTG RCT did not find evidence of increased risk of CVD with abacavir exposure; however, the median age of patients included in the RCTs was significantly lower than in cohort studies [57,59,60].…”

Section: Nucleoside Reverse Transcriptase Inhibitors (Nrti's)mentioning

confidence: 92%

Risk of Cardiovascular Disease in an Aging HIV Population: Where Are We Now?

2015

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With more effective and widespread antiretroviral treatment, the overall incidence of AIDS- or HIV-related death has decreased dramatically. Consequently, as patients are aging, cardiovascular disease (CVD) has emerged as an important cause of morbidity and mortality in the HIV population. The incidence of CVD overall in HIV is relatively low, but it is approximately 1.5-2-fold higher than that seen in age-matched HIV-uninfected individuals. Multiple factors are believed to explain this excess in risk such as overrepresentation of traditional cardiovascular risk factors (particularly smoking), toxicities associated with cumulative exposure to some antiretroviral agents, together with persistent chronic inflammation, and immune activation associated with HIV infection. Tools are available to calculate an individual's predicted risk of CVD and should be incorporated in the regular follow-up of HIV-infected patients. Targeted interventions to reduce this risk must be recommended, including life-style changes and medical interventions that might include changes in antiretroviral therapy.

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“…Possible cardiovascular toxicity of ABC in adults remains controversial. A meta‐analysis of RCTs did not find an increased cardiovascular risk 118 and the biological mechanism of possible cardiovascular toxicity of ABC has not been established. To date, no link to cardiovascular toxicity has been found in ABC‐exposed children.…”

Section: Drug Toxicities and Interactionsmentioning

confidence: 99%

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

et al. 2015

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The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV‐1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short‐term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long‐term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first‐ and second‐line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART ‘pipeline’ of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained.

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Abacavir use and cardiovascular disease events

Abstract: This meta-analysis of RCTs does not support the hypothesis that ABC-containing cART regimens carry a greater risk of MI or major cardiovascular events relative to comparator cART.

Cited by 138 publications

References 40 publications

Risk Factors for Fluconazole-Resistant Candidemia

Risk Factors for Fluconazole-Resistant Candidemia

Risk of Cardiovascular Disease in an Aging HIV Population: Where Are We Now?

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

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