Evidence map›Paper›PMID 31135582›Full record

ArticleJournal of acquired immune deficiency syndromes (1999)2019

Association Between Bilirubin, Atazanavir, and Cardiovascular Disease Events Among People Living With HIV Across the United States.

Heidi M Crane, Robin M Nance, Susan R Heckbert, Corey Ritchings, Lisa Rosenblatt, Matthew Budoff, Brian R Wood, David L Tirschwell, H Nina Kim, William C Mathews and 16 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of acquired immune deficiency syndromes (1999), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
2.3field-weighted citation impact, top 12% of its field
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

7 citing papers in PubMed, 11 citations in OpenAlex.

  1. Article
  2. Article
  3. Review
  4. Review
  5. Article
  6. Article
  7. Metabolic Syndrome in HIV/HCV Co-infected Patients.Current treatment options in infectious diseases · 2019
    Article
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

26 authors at 8 institutions in 1 country.

Heidi M CraneDepartment of Medicine, University of Washington, Seattle, WA.
Robin M NanceDepartment of Medicine, University of Washington, Seattle, WA.
Susan R HeckbertDepartment of Medicine, University of Washington, Seattle, WA.
Corey RitchingsBristol Myers Squibb, Princeton, NJ.
Lisa RosenblattBristol Myers Squibb, Princeton, NJ.
Matthew BudoffDepartment of Medicine, University of California Los Angeles, Los Angeles, CA.
Brian R WoodDepartment of Medicine, University of Washington, Seattle, WA.
David L TirschwellDepartment of Medicine, University of Washington, Seattle, WA.
H Nina KimDepartment of Medicine, University of Washington, Seattle, WA.
William C MathewsDepartment of Medicine, University of California San Diego, San Diego, CA.
Elvin GengDepartment of Medicine, University of California San Francisco, San Francisco, CA.
Richard D MooreDepartment of Medicine, Johns Hopkins University, Baltimore, MD.
Peter W HuntDepartment of Medicine, University of California San Francisco, San Francisco, CA.
Joseph J EronDepartment of Medicine, University of North Carolina, Chapel Hill, NC.
Greer A BurkholderDepartment of Medicine, University of Alabama, Birmingham, AL.
Daniel R DrozdDepartment of Medicine, University of Washington, Seattle, WA.
Felicia C ChowDepartment of Medicine, University of California San Francisco, San Francisco, CA.
Kyra J BeckerDepartment of Medicine, University of Washington, Seattle, WA.
Joseph R ZuntDepartment of Medicine, University of Washington, Seattle, WA.
Emily L HoDepartment of Medicine, University of Washington, Seattle, WA.
Rizwan KalaniDepartment of Medicine, University of Washington, Seattle, WA.
Andrew HufferDepartment of Medicine, University of Washington, Seattle, WA.
Bridget M WhitneyDepartment of Medicine, University of Washington, Seattle, WA.
Michael S SaagDepartment of Medicine, University of Alabama, Birmingham, AL.
Mari M KitahataDepartment of Medicine, University of Washington, Seattle, WA.
Joseph A C DelaneyDepartment of Epidemiology, University of Washington, Seattle, WA.
University of Washington · USUniversity of California, San Francisco · USBristol-Myers Squibb (United States) · USUniversity of Alabama at Birmingham · USJohns Hopkins University · USUniversity of California, Los Angeles · USUniversity of California, San Diego · USUniversity of North Carolina at Chapel Hill · US

Funding

University of Washington/Fred Hutch Center for AIDS ResearchP30AI027757 · NIAID · UNIVERSITY OF WASHINGTON · PI Kenneth Sherr · 1988 to 2026
$104.9M
Unsolicited R24 for the CFAR-Network of Integrated Clinical Sciences, CNICSR24AI067039 · NIAID · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI Michael S. Saag · 2006 to 2026
$99.4M
Virology CoreP30AI027763 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI STEVEN Grant DEEKS · 1988 to 2026
$93.6M
Virology CoreP30AI027767 · NIAID · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI OLAF KUTSCH · 1988 to 2026
$84.1M
Virology, Immunology, and Microbiology CoreP30AI050410 · NIAID · UNIV OF NORTH CAROLINA CHAPEL HILL · PI DAVID M. MARGOLIS · 2001 to 2026
$76.9M
Vaccine Response and Immunotherapeutics SWGP30AI094189 · NIAID · JOHNS HOPKINS UNIVERSITY · PI Richard E. Chaisson · 2012 to 2026
$67.0M
Johns Hopkins HIV Clinical CohortU01DA036935 · NIDA · JOHNS HOPKINS UNIVERSITY · PI MOORE, RICHARD DOUGLAS · 2014 to 2024
$14.9M
Links between Cardiovascular disease, Lung disease, and Obstructive sleep apnea in HIV: Understanding complex patientsR01HL126538 · NHLBI · UNIVERSITY OF WASHINGTON · PI CRANE, HEIDI M., CROTHERS, KRISTINA ANNE · 2015 to 2025
$5.1M
NHLBI NIH HHS R01 HL126538NIAID NIH HHS P30 AI027757NIAID NIH HHS P30 AI027763NIAID NIH HHS P30 AI027767NIAID NIH HHS P30 AI050410NIAID NIH HHS P30 AI094189NIAID NIH HHS R24 AI067039NIDA NIH HHS U01 DA036935
6 · The paper itself

Abstract

objectiveBilirubin is an antioxidant that may suppress lipid oxidation. Elevated bilirubin is associated with decreased cardiovascular events in HIV-uninfected populations. We examined these associations in people living with HIV (PLWH).

methodsPotential myocardial infarctions (MIs) and strokes were centrally adjudicated. We examined MI types: type 1 MI (T1MI) from atherosclerotic plaque instability and type 2 MI (T2MI) in the setting of oxygen demand/supply mismatch such as sepsis. We used multivariable Cox regression analyses to determine associations between total bilirubin levels and outcomes adjusting for traditional and HIV-specific risk factors. To minimize confounding by hepatobiliary disease, we conducted analyses limited to bilirubin values <2.1 mg/dL; among those with fibrosis-4 values <3.25; and among everyone. We repeated analyses stratified by hepatitis C status and time-updated atazanavir use.

resultsAmong 25,816 PLWH, there were 392 T1MI and 356 T2MI during follow-up. Adjusted hazard ratios for the association of higher bilirubin levels with T1MI were not significant. Higher bilirubin levels were associated with T2MI. By contrast, among PLWH on atazanavir, higher bilirubin levels were associated with fewer T2MI (hazard ratio 0.56:0.33-1.00). Higher bilirubin levels among those on atazanavir were associated with fewer T1MI combined with ischemic stroke. LIMITATIONS: Analyses were conducted with total rather than unconjugated bilirubin.

conclusionsAmong PLWH, higher bilirubin levels were associated with T2MI among some subgroups. However, among those on atazanavir, there was a protective association between bilirubin and T2MI. These findings demonstrate different associations between outcomes and elevated bilirubin due to diverse causes and the importance of distinguishing MI types.

Indexed as

AdultAtazanavir SulfateBilirubinFemaleHIV InfectionsHIV Protease InhibitorsHumansMaleMiddle AgedMyocardial InfarctionUnited StatesAtazanavir SulfateBilirubinHIV Protease Inhibitors

Identifiers

PMID31135582
PMCPMC6625840
OpenAlexW2945110072

What OpenQuestion holds

Textmetadata
LicenceTDM
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.