485. Impact of Antiretroviral Medications on Blood Pressure in Antiretroviral Na´ve Patients Initiating Their First Regimen in the CNICS Cohort
Session: Poster Abstract Session: HIV Primary Care
Friday, October 21, 2011
Room: Poster Hall B1
Background: Antiretroviral therapy may affect blood pressure (BP) and subsequent cardiovascular disease risk.  We conducted this study to determine whether elevations in BP differed by initial antiretroviral (ARV) regimen and whether these differences could be driven in part by differences in baseline kidney function.

Methods: Observational cohort study of patients initiating their initial ARV regimen after 2002 across 6 sites in CNICS.  We used mean structural models with and without time and time/regimen intercept terms.  All models adjusted for baseline age, sex, race, intravenous drug use, hepatitis C virus (HCV), nadir CD4 count, peak viral load, baseline BP, diabetes, and time-varying use of antihypertensive and statin medications.  Sensitivity analyses also included baseline kidney function (eGFR). 

Results: Among 1816 patients on any of 9 initial ARV regimens, mean SBP increases were associated with older age, black race, female sex, antihypertensive medications, and not having HCV (+1.4 to +8.3 mmHg, p’s<0.001 to 0.01).  Among those who initiated abacavir/lamivudine/efavirenz, the mean SBP increase was 5.0 mmHg (p=0.002) compared with those who initiated tenofovir/lamivudine/efavirenz.  Patients who initiated abacavir/lamivudine/efavirenz had lower eGFR than non-abacavir containing regimens.  In sensitivity analyses including baseline eGFR, abacavir/lamivudine/efavirenz was associated with a mean SBP increase of 4.7 mmHg, p=0.003. 

Conclusion: Patients who initiated abacavir had greater increases in mean SBP than those whose regimen contained tenofovir.  Patients whose initial regimen contained abacavir vs. tenofovir differed in key baseline covariates such as kidney function and these must be taken into account when comparing outcomes and differences between regimens.  Baseline differences in kidney function did not account for differences between abacavir and tenofovir in SBP.  Further explorations of the impact of other potential differences between those who initiate abacavir vs. tenofovir are needed.  The influence of ARVs on cardiovascular disease risk will likely increasingly influence treatment decisions.


Subject Category: H. HIV/AIDS and other retroviruses

Elizabeth Teeple1, J.A.C. Delaney, PhD2, Elizabeth R. Brown, PhD3, Petra Buzkova, PhD4, Carl Grunfeld, MD, PhD5, Michael J. Mugavero, MD, MHSc6, James H. Willig, MD, MSPH7, Stephen Boswell, MD8, W. Christopher Mathews, MD, MSPH9, Peter Hunt, MD10, Benigno Rodriguez, MD11, Michael S. Saag, MD, FIDSA12, Mari Kitahata, MD, MPH4 and Heidi M. Crane, MD, MPH13, (1)Biostatistics, University of Washington, Seattle, WA, (2)Pharmacy, College of Pharmacy, University of Florida, Gainesville, FL, (3)Department of Biostatistics, University of Washington, Seattle, WA, (4)University of Washington, Seattle, WA, (5)University of California, San Francisco, San Francisco, CA, (6)University of Alabama at Birmingham, Birmingham, AL, (7)UAB, Birmingham, AL, (8)Fenway CommunityHealth Center, Boston, MA, (9)University of San Diego, San Diego, CA, (10)University Of California, San Francisco, San Francisco, CA, (11)Case Western Reserve University/University Hospitals of Cleveland Center for AIDS Research, Cleveland, OH, (12)Univ. of Alabama, Birmingham, AL, (13)Medicine/Infectious Diseases, University of Washington, Seattle, WA

Disclosures:

E. Teeple, None

J. A. C. Delaney, None

E. R. Brown, None

P. Buzkova, None

C. Grunfeld, None

M. J. Mugavero, Bristol Myers Squibb: Grant Investigator and Scientific Advisor, Consulting fee and Research grant
Gilead Sciences: Research Contractor and Scientific Advisor, Consulting fee
Tibotec Therapeutics: Grant Investigator, Research grant
Pfizer: Grant Investigator, Research grant
Definicare: Grant Investigator, Research grant

J. H. Willig, Bristol Myers Squibb: Grant Investigator, Research grant and Research support
Definicare: Grant Investigator, Research grant
Gilead: Grant Investigator, Research support
Pfizer: Grant Investigator, Research support

S. Boswell, None

W. C. Mathews, None

P. Hunt, Gilead: Speaker's Bureau, Speaker honorarium
Pfizer: Grant Investigator, Grant recipient
Merck: Consultant, Consulting fee

B. Rodriguez, None

M. S. Saag, Merck: Consultant and Scientific Advisor, Consulting fee
Ardea: Consultant and Scientific Advisor, Consulting fee
Boehringer: Consultant and Scientific Advisor, Consulting fee
Ingelheim: Consultant and Scientific Advisor, Consulting fee
BMS: Consultant and Scientific Advisor, Consulting fee
Gilead: Consultant and Scientific Advisor, Consulting fee
GSK: Consultant and Scientific Advisor, Consulting fee
Pfizer: Consultant and Scientific Advisor, Consulting fee
VIiV: Consultant and Scientific Advisor, Consulting fee
Tibotec: Consultant and Scientific Advisor, Consulting fee
Vertex: Scientific Advisor, Consulting fee
Monogram BioSciences: Research Contractor, Research support
NIH/NIAID: Grant Investigator, Grant recipient

M. Kitahata, None

H. M. Crane, None

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