Macrolide use and the risk of vascular disease in HIV-infected men in the Multicenter AIDS Cohort Study
Ian J. Woolley A E , Xiuhong Li B , Lisa P. Jacobson B , Frank J. Palella C and Lars Ostergaard DA Infectious Diseases Department, Alfred Hospital, Monash University Medical School, Prahran 3004, Victoria, Australia.
B Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
C Northwestern University, Feinberg School of Medicine, Division of Infectious Diseases, Chicago, Illinois 60611, USA.
D Research Unit Q, Department of Infectious Diseases, Skejby Sygehus, Aarhus University Hospital, 8200 Aarhus N, Denmark.
E Corresponding author. Email: Ian.Woolley@med.monash.edu.au
Sexual Health 4(2) 111-119 https://doi.org/10.1071/SH06052
Submitted: 8 September 2006 Accepted: 26 March 2007 Published: 23 May 2007
Abstract
Background: There has been increasing concern that HIV-infected individuals may be more at risk for cardiovascular events in the highly-active antiretroviral therapy (HAART) era. This study examined the risk of thromboembolic events in HIV-infected and non-infected individuals and the effect of macrolide prophylaxis on those outcomes. Methods: A subcohort analysis was undertaken using data collected in the Multicenter AIDS Cohort Study to examine the relative risk of vascular events (myocardial infarction, unstable angina and ischaemic stroke). Cox proportional hazard model using age as the time scale with time varying cofactors obtained at each semi-annual visit were used to assess the independent effect of macrolide use. Results: Controlling for other significant effects including race and smoking, HIV-infection was not independently associated with vascular events. Increased risk was observed among those who used HAART (relative hazard 1.09, 95% confidence intervals 1.00–1.19 in multivariate model), antihypertensive treatment (1.81 [1.26–2.60]), lipid-lowering medication (1.65 [1.12–2.42]), and antibiotics (1.72 [1.25–2.36]). The protective association of macrolide use for a vascular event in the HAART era was also significant (0.10 [0.01–0.75]). Conclusions: Traditional risk factors are important in the pathogenesis of vascular events in HIV-infected individuals. Macrolide antibiotics may have a protective effect in the HIV-infected individuals in the HAART era.
Additional keywords: HIV, macrolide, myocardial infarct, vascular event.
Acknowledgements
Data in this manuscript were collected by the Multicenter AIDS Cohort Study (MACS) with centres (Principal Investigators) at The Johns Hopkins University Bloomberg School of Public Health (Joseph B. Margolick, Lisa Jacobson), Howard Brown Health Center and North-western University Medical School (John Phair), University of California, Los Angeles (Roger Detels, Beth Jamieson), and University of Pittsburgh (Charles Rinaldo). MACS is funded by the National Institute of Allergy and Infectious Diseases, with additional supplemental funding from the National Cancer Institute. UO1-AI-35042, 5-MO1-RR-00722 (GCRC), UO1-AI-35043, UO1-AI-37984, UO1-AI-35039, UO1-AI-35040, UO1-AI-37613, UO1-AI-35041. The website is located at http://www.statepi.jhsph.edu/macs/macs.html. Thanks to Søren P. Johnsen and Henrik T. Sorensen for their contributions to this paper.
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