Evidence map›Paper›PMID 23555704›Full record

SynthesisPloS one2013

Risk of cardiovascular disease from antiretroviral therapy for HIV: a systematic review.

Clay Bavinger, Eran Bendavid, Katherine Niehaus, Richard A Olshen, Ingram Olkin, Vandana Sundaram, Nicole Wein, Mark Holodniy, Nanjiang Hou, Douglas K Owens and 1 more

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 111 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
111citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

111 citing papers in PubMed, 10 syntheses or guidelines pooled it.

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51 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Clay BavingerCenter for Primary Care and Outcomes Research, and Center for Health Policy, Stanford University, Stanford, California, United States of America. claybavinger@gmail.com
Eran Bendavid
Katherine Niehaus
Richard A Olshen
Ingram Olkin
Vandana Sundaram
Nicole Wein
Mark Holodniy
Nanjiang Hou
Douglas K Owens
Manisha Desai

Funding

Making Better Decisions: Policy Modeling for AIDS and Drug AbuseR01DA015612 · NIDA · STANFORD UNIVERSITY · PI OWENS, DOUGLAS K · 2002 to 2017
$9.4M
Adaptation of New Statistical Ideas for MedicineR37EB002784 · NIBIB · STANFORD UNIVERSITY · PI EFRON, BRADLEY · 2006 to 2014
$1.9M
Comparative effectiveness of ART for HIV in patients with comorbiditiesRC1AI086927 · NIAID · STANFORD UNIVERSITY · PI OWENS, DOUGLAS K · 2009 to 2010
$972k
NIAID NIH HHS 1RC1AI086927-01NIAID NIH HHS RC1 AI086927NIBIB NIH HHS R37 EB002784NIDA NIH HHS 2 R01 DA15612-016NIDA NIH HHS R01 DA015612
6 · The paper itself

Abstract

backgroundRecent studies suggest certain antiretroviral therapy (ART) drugs are associated with increases in cardiovascular disease. PURPOSE: We performed a systematic review and meta-analysis to summarize the available evidence, with the goal of elucidating whether specific ART drugs are associated with an increased risk of myocardial infarction (MI). DATA SOURCES: We searched Medline, Web of Science, the Cochrane Library, and abstract archives from the Conference on Retroviruses and Opportunistic Infections and International AIDS Society up to June 2011 to identify published articles and abstracts. STUDY SELECTION: Eligible studies were comparative and included MI, strokes, or other cardiovascular events as outcomes. DATA EXTRACTION: Eligibility screening, data extraction, and quality assessment were performed independently by two investigators. DATA SYNTHESIS: Random effects methods and Fisher's combined probability test were used to summarize evidence.

findingsTwenty-seven studies met inclusion criteria, with 8 contributing to a formal meta-analysis. Findings based on two observational studies indicated an increase in risk of MI for patients recently exposed (usually defined as within last 6 months) to abacavir (RR 1.92, 95% CI 1.51-2.42) and protease inhibitors (PI) (RR 2.13, 95% CI 1.06-4.28). Our analysis also suggested an increased risk associated with each additional year of exposure to indinavir (RR 1.11, 95% CI 1.05-1.17) and lopinavir (RR 1.22, 95% CI 1.01-1.47). Our findings of increased cardiovascular risk from abacavir and PIs were in contrast to four published meta-analyses based on secondary analyses of randomized controlled trials, which found no increased risk from cardiovascular disease.

conclusionAlthough observational studies implicated specific drugs, the evidence is mixed. Further, meta-analyses of randomized trials did not find increased risk from abacavir and PIs. Our findings that implicate specific ARTs in the observational setting provide sufficient evidence to warrant further investigation of this relationship in studies designed for that purpose.

Indexed as

Anti-HIV AgentsCardiovascular DiseasesHumansProtease InhibitorsReverse Transcriptase InhibitorsRiskAnti-HIV AgentsProtease InhibitorsReverse Transcriptase Inhibitors

Identifiers

PMID23555704
PMCPMC3608726

What OpenQuestion holds

Textmetadata
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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.