Abacavir Linked to Increased Risk for Cardiovascular Disease in PLWHIV

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Risk and benefits should be weighed in prescribing abacavir-based anti-retroviral regimens for people living with HIV.
Risk and benefits should be weighed in prescribing abacavir-based anti-retroviral regimens for people living with HIV.

Exposure to abacavir is associated with an increased risk for cardiovascular disease (CVD) in individuals infected with HIV, according to study results published in the International Journal of Antimicrobial Agents.

Abacavir use was first associated with an increased risk for acute myocardial infarction (AMI) in people living with HIV (PLWHIV) approximately a decade ago, but subsequent studies have yielded conflicting results. The study authors performed an updated systematic review and meta-analysis that included 17 studies in order to better summarize the relationship between recent (including current) and cumulative exposure to abacavir or abacavir-based drug regimens and the risk for CVD in individuals living with HIV.

A total of 16 studies (1 was excluded) showed an increased risk for CVD from recent exposure to abacavir, with 13 reaching statistical significance, demonstrating a summary relative risk (sRR) of 1.61 and 95% CI, 1.48-1.75 for recent exposure. There was an increased sRR for CVD of 1.12 (95% CI, 1.05-1.20) from cumulative exposure to abacavir (per year) in studies that did not adjust for recent exposure, but there was no increased risk (sRR, 1.00; 95% CI, 0.93-1.08) in studies that did adjust for recent exposure.

Overall, the study authors found that there was a 61% increased risk for CVD from recent exposure to abacavir vs not receiving abacavir and there was a higher summary risk in antiretroviral therapy naïve individuals with a recent exposure to abacavir.

“Risk and benefits should be weighed in prescribing abacavir based anti-retroviral regimens to persons living with HIV,” wrote the study authors, adding that research is needed to “identify a clear underlying biological mechanism that corroborates the clinical evidence.”

Reference

Dorjee K, Choden T, Baxi SM, Steinmaus C, Reingold AL. Risk of cardiovascular disease associated with exposure to abacavir among individuals with HIV: a systematic review and meta-analyses of results from seventeen epidemiologic studies [published online July 28, 2018] Int J Antimicrob Agents. doi:10.1016/j.ijantimicag.2018.07.010

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