Association Between ALT Level and the Rate of Cardio/Cerebrovascular Events in HIV-Positive Individuals: The D:A:D Study
Identifieur interne : 005087 ( Main/Exploration ); précédent : 005086; suivant : 005088Association Between ALT Level and the Rate of Cardio/Cerebrovascular Events in HIV-Positive Individuals: The D:A:D Study
Auteurs : Caroline A. Sabin [Royaume-Uni] ; Lene Ryom [Danemark, Suisse] ; Helen Kovari [Danemark] ; Ole Kirk [Danemark, Suisse] ; Stephane De Wit [Belgique] ; Matthew Law [Australie] ; Peter Reiss [Pays-Bas] ; Francois Dabis [France] ; Christian Pradier [France] ; Wafaa El-Sadr [États-Unis] ; Antonella D'Arminio Monforte [Italie] ; David Kamara [Royaume-Uni] ; Andrew N. Phillips [Royaume-Uni] ; Jens D. Lundgren [Danemark, Suisse]Source :
- Journal of acquired immune deficiency syndromes : (1999) [ 1525-4135 ] ; 2013.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
Abstract
Background: An inverse association between serum alanine aminotransferase (ALT) levels and the risk of myocardial infarction (MI) has been reported in the general population. We investigated associations between ALT levels and the risk of various cardiovascular and cerebrovascular outcomes in a large cohort study of HIV-positive individuals. Methods: Using Poisson regression, we investigated associations between the latest ALT level and MI, coronary heart disease (CHD), and stroke, after adjusting for known confounders and cumulative/ recent exposure to antiretroviral drugs. Analyses were also performed for the end points of all-cause/liver-related mortality and new-onset diabetes mellitus. Results: By February 2011, participants had experienced 541 MIs, 804 CHD, and 258 stroke events. The MI rate decreased from 3.1/1000 person-years among those with ALT ≤18 U/L to 2.1/1000 person-years among those with ALT >60 U/L. After adjustment for confounders, each 2-fold increment in ALT was associated with a 19% drop in the MI rate {relative rate, 0.81 [95% confidence interval (CI): 0.74 to 0.89], P = 0.0001}. A weaker inverse association was seen for CHD with no indication of a linear association between ALT levels and stroke (P = 0.72). Adjusted relative rates were 0.88 (95% CI: 0.81 to 0.97) and 0.70 (95% CI: 0.54 to 0.92) in those who were hepatitis C virus negative and hepatitis C virus positive, respectively, and 0.72 (95% CI: 0.58 to 0.89) and 0.84 (0.77 to 0.93) in injection drug users and non-injection drug users, respectively. Liver-related mortality and diabetes both demonstrated a positive association with ALT levels, whereas all-cause mortality showed a U-shaped relationship. Conclusions: Higher ALT levels are associated with lower MI risk in HIV-positive individuals, but with higher risks of liver-related mortality and diabetes mellitus.
Affiliations:
- Australie, Belgique, Danemark, France, Italie, Pays-Bas, Royaume-Uni, Suisse, États-Unis
- Angleterre, Aquitaine, Canton de Zurich, Grand Londres, Hollande-Septentrionale, Hovedstaden, Lombardie, Nouvelle-Aquitaine, Nouvelle-Galles du Sud, Provence-Alpes-Côte d'Azur, Région de Bruxelles-Capitale
- Amsterdam, Bordeaux, Bruxelles, Copenhague, Londres, Milan, Nice, Sydney, Zurich
- Université de Zurich
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Sabin</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Research Department of Infection and Population Health, UCL</s1><s2>London</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Ryom, Lene" sort="Ryom, Lene" uniqKey="Ryom L" first="Lene" last="Ryom">Lene Ryom</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Copenhagen HIV Programme, University of Copenhagen</s1><s2>Copenhagen</s2><s3>DNK</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Danemark</country><placeName><settlement type="city">Copenhague</settlement><region type="région" nuts="2">Hovedstaden</region></placeName></affiliation><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Division of Infectious Diseases and Hospital 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i1="02"><s1>Copenhagen HIV Programme, University of Copenhagen</s1><s2>Copenhagen</s2><s3>DNK</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Danemark</country><placeName><settlement type="city">Copenhague</settlement><region type="région" nuts="2">Hovedstaden</region></placeName></affiliation><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich</s1><s2>Zurich</s2><s3>CHE</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Zurich</settlement><region nuts="3" type="region">Canton de Zurich</region></placeName><orgName type="university">Université de Zurich</orgName></affiliation></author><author><name sortKey="De Wit, Stephane" sort="De Wit, Stephane" uniqKey="De Wit S" first="Stephane" last="De Wit">Stephane De Wit</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Department of Infectious Diseases, CHU Saint-Pierre Hospital</s1><s2>Brussels</s2><s3>BEL</s3><sZ>5 aut.</sZ></inist:fA14><country>Belgique</country><placeName><settlement type="city">Bruxelles</settlement><region nuts="2">Région de Bruxelles-Capitale</region></placeName></affiliation></author><author><name sortKey="Law, Matthew" sort="Law, Matthew" uniqKey="Law M" first="Matthew" last="Law">Matthew Law</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Kirby Institute, University of New South Wales</s1><s2>Sydney</s2><s3>AUS</s3><sZ>6 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Reiss, Peter" sort="Reiss, Peter" uniqKey="Reiss P" first="Peter" last="Reiss">Peter Reiss</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Academic Medical Center</s1><s2>Amsterdam</s2><s3>NLD</s3><sZ>7 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author><author><name sortKey="Dabis, Francois" sort="Dabis, Francois" uniqKey="Dabis F" first="Francois" last="Dabis">Francois Dabis</name><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique and INSERM, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique</s1><s2>Bordeaux</s2><s3>FRA</s3><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Nouvelle-Aquitaine</region><region type="old region">Aquitaine</region><settlement type="city">Bordeaux</settlement></placeName></affiliation></author><author><name sortKey="Pradier, Christian" sort="Pradier, Christian" uniqKey="Pradier C" first="Christian" last="Pradier">Christian Pradier</name><affiliation wicri:level="3"><inist:fA14 i1="09"><s1>Département de santé publique, Centre Hospitalier Universitaire, Nice-Sophia-Antipolis University</s1><s2>Nice</s2><s3>FRA</s3><sZ>9 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old region">Provence-Alpes-Côte d'Azur</region><settlement type="city">Nice</settlement></placeName></affiliation></author><author><name sortKey="El Sadr, Wafaa" sort="El Sadr, Wafaa" uniqKey="El Sadr W" first="Wafaa" last="El-Sadr">Wafaa El-Sadr</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>ICAP, Columbia University/Harlem Hospital</s1><s2>New York, NY</s2><s3>USA</s3><sZ>10 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>New York, NY</wicri:noRegion></affiliation></author><author><name sortKey="D Arminio Monforte, Antonella" sort="D Arminio Monforte, Antonella" uniqKey="D Arminio Monforte A" first="Antonella" last="D'Arminio Monforte">Antonella D'Arminio Monforte</name><affiliation wicri:level="3"><inist:fA14 i1="11"><s1>Infectious Diseases Unit, Department of Health Sciences, University of Milan, San Paolo University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Kamara, David" sort="Kamara, David" uniqKey="Kamara D" first="David" last="Kamara">David Kamara</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Research Department of Infection and Population Health, UCL</s1><s2>London</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Phillips, Andrew N" sort="Phillips, Andrew N" uniqKey="Phillips A" first="Andrew N." last="Phillips">Andrew N. Phillips</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Research Department of Infection and Population Health, UCL</s1><s2>London</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Lundgren, Jens D" sort="Lundgren, Jens D" uniqKey="Lundgren J" first="Jens D." last="Lundgren">Jens D. Lundgren</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Copenhagen HIV Programme, University of Copenhagen</s1><s2>Copenhagen</s2><s3>DNK</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Danemark</country><placeName><settlement type="city">Copenhague</settlement><region type="région" nuts="2">Hovedstaden</region></placeName></affiliation><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich</s1><s2>Zurich</s2><s3>CHE</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Zurich</settlement><region nuts="3" type="region">Canton de Zurich</region></placeName><orgName type="university">Université de Zurich</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">13-0237587</idno><date when="2013">2013</date><idno type="stanalyst">PASCAL 13-0237587 INIST</idno><idno type="RBID">Pascal:13-0237587</idno><idno type="wicri:Area/PascalFrancis/Corpus">000948</idno><idno type="wicri:Area/PascalFrancis/Curation">005528</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000A98</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000A98</idno><idno type="wicri:doubleKey">1525-4135:2013:Sabin C:association:between:alt</idno><idno type="wicri:Area/Main/Merge">005272</idno><idno type="wicri:Area/Main/Curation">005087</idno><idno type="wicri:Area/Main/Exploration">005087</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Association Between ALT Level and the Rate of Cardio/Cerebrovascular Events in HIV-Positive Individuals: The D:A:D Study</title><author><name sortKey="Sabin, Caroline A" sort="Sabin, Caroline A" uniqKey="Sabin C" first="Caroline A." last="Sabin">Caroline A. Sabin</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Research Department of Infection and Population Health, UCL</s1><s2>London</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Ryom, Lene" sort="Ryom, Lene" uniqKey="Ryom L" first="Lene" last="Ryom">Lene Ryom</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Copenhagen HIV Programme, University of Copenhagen</s1><s2>Copenhagen</s2><s3>DNK</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Danemark</country><placeName><settlement type="city">Copenhague</settlement><region type="région" nuts="2">Hovedstaden</region></placeName></affiliation><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich</s1><s2>Zurich</s2><s3>CHE</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Zurich</settlement><region nuts="3" type="region">Canton de Zurich</region></placeName><orgName type="university">Université de Zurich</orgName></affiliation></author><author><name sortKey="Kovari, Helen" sort="Kovari, Helen" uniqKey="Kovari H" first="Helen" last="Kovari">Helen Kovari</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Epidemiklinikken M5132, Copenhagen Univ Hosp/Rigshospitalet</s1><s2>Copenhagen</s2><s3>DNK</s3><sZ>3 aut.</sZ></inist:fA14><country>Danemark</country><placeName><settlement type="city">Copenhague</settlement><region type="région" nuts="2">Hovedstaden</region></placeName></affiliation></author><author><name sortKey="Kirk, Ole" sort="Kirk, Ole" uniqKey="Kirk O" first="Ole" last="Kirk">Ole Kirk</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Copenhagen HIV Programme, University of Copenhagen</s1><s2>Copenhagen</s2><s3>DNK</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Danemark</country><placeName><settlement type="city">Copenhague</settlement><region type="région" nuts="2">Hovedstaden</region></placeName></affiliation><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich</s1><s2>Zurich</s2><s3>CHE</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Zurich</settlement><region nuts="3" type="region">Canton de Zurich</region></placeName><orgName type="university">Université de Zurich</orgName></affiliation></author><author><name sortKey="De Wit, Stephane" sort="De Wit, Stephane" uniqKey="De Wit S" first="Stephane" last="De Wit">Stephane De Wit</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Department of Infectious Diseases, CHU Saint-Pierre Hospital</s1><s2>Brussels</s2><s3>BEL</s3><sZ>5 aut.</sZ></inist:fA14><country>Belgique</country><placeName><settlement type="city">Bruxelles</settlement><region nuts="2">Région de Bruxelles-Capitale</region></placeName></affiliation></author><author><name sortKey="Law, Matthew" sort="Law, Matthew" uniqKey="Law M" first="Matthew" last="Law">Matthew Law</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Kirby Institute, University of New South Wales</s1><s2>Sydney</s2><s3>AUS</s3><sZ>6 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Reiss, Peter" sort="Reiss, Peter" uniqKey="Reiss P" first="Peter" last="Reiss">Peter Reiss</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Academic Medical Center</s1><s2>Amsterdam</s2><s3>NLD</s3><sZ>7 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author><author><name sortKey="Dabis, Francois" sort="Dabis, Francois" uniqKey="Dabis F" first="Francois" last="Dabis">Francois Dabis</name><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique and INSERM, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique</s1><s2>Bordeaux</s2><s3>FRA</s3><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Nouvelle-Aquitaine</region><region type="old region">Aquitaine</region><settlement type="city">Bordeaux</settlement></placeName></affiliation></author><author><name sortKey="Pradier, Christian" sort="Pradier, Christian" uniqKey="Pradier C" first="Christian" last="Pradier">Christian Pradier</name><affiliation wicri:level="3"><inist:fA14 i1="09"><s1>Département de santé publique, Centre Hospitalier Universitaire, Nice-Sophia-Antipolis University</s1><s2>Nice</s2><s3>FRA</s3><sZ>9 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old region">Provence-Alpes-Côte d'Azur</region><settlement type="city">Nice</settlement></placeName></affiliation></author><author><name sortKey="El Sadr, Wafaa" sort="El Sadr, Wafaa" uniqKey="El Sadr W" first="Wafaa" last="El-Sadr">Wafaa El-Sadr</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>ICAP, Columbia University/Harlem Hospital</s1><s2>New York, NY</s2><s3>USA</s3><sZ>10 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>New York, NY</wicri:noRegion></affiliation></author><author><name sortKey="D Arminio Monforte, Antonella" sort="D Arminio Monforte, Antonella" uniqKey="D Arminio Monforte A" first="Antonella" last="D'Arminio Monforte">Antonella D'Arminio Monforte</name><affiliation wicri:level="3"><inist:fA14 i1="11"><s1>Infectious Diseases Unit, Department of Health Sciences, University of Milan, San Paolo University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Kamara, David" sort="Kamara, David" uniqKey="Kamara D" first="David" last="Kamara">David Kamara</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Research Department of Infection and Population Health, UCL</s1><s2>London</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Phillips, Andrew N" sort="Phillips, Andrew N" uniqKey="Phillips A" first="Andrew N." last="Phillips">Andrew N. Phillips</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Research Department of Infection and Population Health, UCL</s1><s2>London</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Lundgren, Jens D" sort="Lundgren, Jens D" uniqKey="Lundgren J" first="Jens D." last="Lundgren">Jens D. Lundgren</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Copenhagen HIV Programme, University of Copenhagen</s1><s2>Copenhagen</s2><s3>DNK</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Danemark</country><placeName><settlement type="city">Copenhague</settlement><region type="région" nuts="2">Hovedstaden</region></placeName></affiliation><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich</s1><s2>Zurich</s2><s3>CHE</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Zurich</settlement><region nuts="3" type="region">Canton de Zurich</region></placeName><orgName type="university">Université de Zurich</orgName></affiliation></author></analytic><series><title level="j" type="main">Journal of acquired immune deficiency syndromes : (1999)</title><title level="j" type="abbreviated">J. acquir. immune defic. syndr. : (1999)</title><idno type="ISSN">1525-4135</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of acquired immune deficiency syndromes : (1999)</title><title level="j" type="abbreviated">J. acquir. immune defic. syndr. : (1999)</title><idno type="ISSN">1525-4135</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term><term>Alanine transaminase</term><term>Cardiovascular disease</term><term>Coronary heart disease</term><term>Myocardial infarction</term><term>Stroke</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Alanine transaminase</term><term>Pathologie de l'appareil circulatoire</term><term>Cardiopathie coronaire</term><term>Accident cérébrovasculaire</term><term>SIDA</term><term>Infarctus du myocarde</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: An inverse association between serum alanine aminotransferase (ALT) levels and the risk of myocardial infarction (MI) has been reported in the general population. We investigated associations between ALT levels and the risk of various cardiovascular and cerebrovascular outcomes in a large cohort study of HIV-positive individuals. Methods: Using Poisson regression, we investigated associations between the latest ALT level and MI, coronary heart disease (CHD), and stroke, after adjusting for known confounders and cumulative/ recent exposure to antiretroviral drugs. Analyses were also performed for the end points of all-cause/liver-related mortality and new-onset diabetes mellitus. Results: By February 2011, participants had experienced 541 MIs, 804 CHD, and 258 stroke events. The MI rate decreased from 3.1/1000 person-years among those with ALT ≤18 U/L to 2.1/1000 person-years among those with ALT >60 U/L. After adjustment for confounders, each 2-fold increment in ALT was associated with a 19% drop in the MI rate {relative rate, 0.81 [95% confidence interval (CI): 0.74 to 0.89], P = 0.0001}. A weaker inverse association was seen for CHD with no indication of a linear association between ALT levels and stroke (P = 0.72). Adjusted relative rates were 0.88 (95% CI: 0.81 to 0.97) and 0.70 (95% CI: 0.54 to 0.92) in those who were hepatitis C virus negative and hepatitis C virus positive, respectively, and 0.72 (95% CI: 0.58 to 0.89) and 0.84 (0.77 to 0.93) in injection drug users and non-injection drug users, respectively. Liver-related mortality and diabetes both demonstrated a positive association with ALT levels, whereas all-cause mortality showed a U-shaped relationship. Conclusions: Higher ALT levels are associated with lower MI risk in HIV-positive individuals, but with higher risks of liver-related mortality and diabetes mellitus.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Belgique</li><li>Danemark</li><li>France</li><li>Italie</li><li>Pays-Bas</li><li>Royaume-Uni</li><li>Suisse</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Aquitaine</li><li>Canton de Zurich</li><li>Grand Londres</li><li>Hollande-Septentrionale</li><li>Hovedstaden</li><li>Lombardie</li><li>Nouvelle-Aquitaine</li><li>Nouvelle-Galles du Sud</li><li>Provence-Alpes-Côte d'Azur</li><li>Région de Bruxelles-Capitale</li></region><settlement><li>Amsterdam</li><li>Bordeaux</li><li>Bruxelles</li><li>Copenhague</li><li>Londres</li><li>Milan</li><li>Nice</li><li>Sydney</li><li>Zurich</li></settlement><orgName><li>Université de Zurich</li></orgName></list><tree><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Sabin, Caroline A" sort="Sabin, Caroline A" uniqKey="Sabin C" first="Caroline A." last="Sabin">Caroline A. Sabin</name></region><name sortKey="Kamara, David" sort="Kamara, David" uniqKey="Kamara D" first="David" last="Kamara">David Kamara</name><name sortKey="Phillips, Andrew N" sort="Phillips, Andrew N" uniqKey="Phillips A" first="Andrew N." last="Phillips">Andrew N. Phillips</name></country><country name="Danemark"><region name="Hovedstaden"><name sortKey="Ryom, Lene" sort="Ryom, Lene" uniqKey="Ryom L" first="Lene" last="Ryom">Lene Ryom</name></region><name sortKey="Kirk, Ole" sort="Kirk, Ole" uniqKey="Kirk O" first="Ole" last="Kirk">Ole Kirk</name><name sortKey="Kovari, Helen" sort="Kovari, Helen" uniqKey="Kovari H" first="Helen" last="Kovari">Helen Kovari</name><name sortKey="Lundgren, Jens D" sort="Lundgren, Jens D" uniqKey="Lundgren J" first="Jens D." last="Lundgren">Jens D. Lundgren</name></country><country name="Suisse"><region name="Canton de Zurich"><name sortKey="Ryom, Lene" sort="Ryom, Lene" uniqKey="Ryom L" first="Lene" last="Ryom">Lene Ryom</name></region><name sortKey="Kirk, Ole" sort="Kirk, Ole" uniqKey="Kirk O" first="Ole" last="Kirk">Ole Kirk</name><name sortKey="Lundgren, Jens D" sort="Lundgren, Jens D" uniqKey="Lundgren J" first="Jens D." last="Lundgren">Jens D. Lundgren</name></country><country name="Belgique"><region name="Région de Bruxelles-Capitale"><name sortKey="De Wit, Stephane" sort="De Wit, Stephane" uniqKey="De Wit S" first="Stephane" last="De Wit">Stephane De Wit</name></region></country><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Law, Matthew" sort="Law, Matthew" uniqKey="Law M" first="Matthew" last="Law">Matthew Law</name></region></country><country name="Pays-Bas"><region name="Hollande-Septentrionale"><name sortKey="Reiss, Peter" sort="Reiss, Peter" uniqKey="Reiss P" first="Peter" last="Reiss">Peter Reiss</name></region></country><country name="France"><region name="Nouvelle-Aquitaine"><name sortKey="Dabis, Francois" sort="Dabis, Francois" uniqKey="Dabis F" first="Francois" last="Dabis">Francois Dabis</name></region><name sortKey="Pradier, Christian" sort="Pradier, Christian" uniqKey="Pradier C" first="Christian" last="Pradier">Christian Pradier</name></country><country name="États-Unis"><noRegion><name sortKey="El Sadr, Wafaa" sort="El Sadr, Wafaa" uniqKey="El Sadr W" first="Wafaa" last="El-Sadr">Wafaa El-Sadr</name></noRegion></country><country name="Italie"><region name="Lombardie"><name sortKey="D Arminio Monforte, Antonella" sort="D Arminio Monforte, Antonella" uniqKey="D Arminio Monforte A" first="Antonella" last="D'Arminio Monforte">Antonella D'Arminio Monforte</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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