No association between atazanavir and MI or stroke in D:A:D study

An update from the D:A:D cohort on the risk of cardiovascular events was presented as a poster. The D:A:D is a large cohort that includes more than 49,000 HIV positive people from Europe, Australia and the US that in recent years has become sufficiently powered to be able to look at associations between safety outcomes and individual HIV drugs.

The cohort now includes 844 cases of myocardial infarction and 523 strokes, both from over 300,000 patient years of follow up (PYFU) and this year accrued sufficient data on atazanavir (>37,000 PYFU) to present this analysis. Previous associations had been reported for cumulative exposure to indinavir and lopinavir/r but not for saquinavir or fosamprenavir.

The rate of MI was 0.28 /100 PYFY (95%CI 0.26 to 2.30) in those with no exposure to atazanavir and 0.20 (0.12 to 0.32) in those with >3 years exposure. The rate of stroke was 0.17 (0.16 to 0.19) and 0.17 (0.10 to 0.27) in the same groups respectively.

The relative rates (RR) for MI and stroke were 0.95 (95%CI: 0.87, 1.05; p=0.30) and 0.90 (95%CI: 0.81, 1.01; p=0.07) after adjustment for clinical and demographic factors including ARV use. No association was seen with cumulative exposure (<1, 1-2, 2-3, >3 years) or after further adjustment for bilirubin. Rates were similar for atazanavir used with and without ritonavir.

Table 1: Rate (95%CI) of MI or stoke and exposure to atazanavir
	No ATV	>3 years
MI	0.28 (0.26 to 2.30)	0.20 (0.12 to 0.32)
Stroke	0.17 (0.16 to 0.19)	0.17 (0.10 to 0.27)

Table 1: Rate (95%CI) of MI or stoke and exposure to atazanavir

No ATV

>3 years

0.28 (0.26 to 2.30)

0.20 (0.12 to 0.32)

Stroke

0.17 (0.16 to 0.19)

0.17 (0.10 to 0.27)

d’Arminio Monforte A et al. ATV-containing ART is not associated with an increased risk of cardio- or cerebro-vascular events in the D:A:D study. 19th Conference of Retroviruses and Opportunistic Infections, 5–8 March 2012, Seattle. Poster abstract 823.