Risk of cardiovascular events from current, recent, and cumulative exposure to abacavir among persons living with HIV who were receiving antiretroviral therapy in the United States: a cohort study

Abstract

BackgroundThere is ongoing controversy regarding abacavir use in the treatment of HIV infection and the risk of subsequent development of cardiovascular disease. It is unclear how the risk varies as exposure accumulates.MethodsUsing an administrative health-plan dataset, risk of cardiovascular disease events (CVDe), defined as the first episode of an acute myocardial infarction or a coronary intervention procedure, associated with abacavir exposure was assessed among HIV-infected individuals receiving antiretroviral therapy across the U.S. from October 2009 through December 2014. The data were longitudinal, and analyzed using marginal structural models.ResultsOver 114,470 person-years (n = 72,733) of ART exposure, 714 CVDe occurred at an incidence rate (IR) (95% CI) of 6·23 (5·80, 6·71)/1000 person-years. Individuals exposed to abacavir had a higher IR of CVDe of 9·74 (8·24, 11·52)/1000 person-years as compared to 5·75 (5·30, 6·24)/1000 person-years for those exposed to other antiretroviral agents. The hazard (HR; 95% CI) of CVDe was increased for current (1·43; 1·18, 1·73), recent (1·41; 1·16, 1·70), and cumulative [(1·18; 1·06, 1·31) per year] exposure to abacavir. The risk for cumulative exposure followed a bell-shaped dose-response curve peaking at 24-months of exposure. Risk was similarly elevated among participants free of pre-existing heart disease or history of illicit substance use at baseline.ConclusionCurrent, recent, and cumulative use of abacavir was associated with an increased risk of CVDe. The findings were consistent irrespective of underlying cardiovascular risk factors.Electronic supplementary materialThe online version of this article (10.1186/s12879-017-2808-8) contains supplementary material, which is available to authorized users.

Comparative study of antiretroviral drug regimens and drug–drug interactions between younger and older HIV-infected patients at a tertiary care teaching hospital in South Korea

“… 36 The HR of CVD events for cumulative exposure to ABC also increased for up to 24 months and decreased thereafter. 36 Consequently, ABC should be cautiously used in HIV-infected patients, especially those aged ≥50 years, and patients with risk factors (such as HTN, hyperlipidemia, DM, and smoking) for coronary artery disease and myocardial infarction, by appropriately managing those risk factors prior to initiating regimens containing ABC.…”

“… 31 , 36 According to the study that assessed the risk of CVD events in HIV-infected patients administered with ARV drugs, a higher incidence rate of CVD events was observed in the patients who were currently exposed to ABC than in those who were currently exposed to other ARV drugs (9.74/1,000 person-years vs 5.75/1,000 person-years). 36 The HRs of CVD events for patients under current (1.43; P =0.001), recent (1.41; P =0.001), and cumulative (1.18 [per year]; P =0.002) exposure to ABC increased with statistical significance. 36 The HR of CVD events for cumulative exposure to ABC also increased for up to 24 months and decreased thereafter.…”

Prediction of cardiovascular risk among male patients infected with human immunodeficiency virus in Vojvodina, Serbia: A single centre study

“…This implicates that in our study the sample size or other parameters, rather than antiretroviral therapy exposure or duration of the treatment, contribute to CVD risk. However, we cannot underestimate the role of some drugs, for example abacavir and duration of exposure, as well as the duration of HIV infection prior to the treatment [21,22].…”

HIV-associated cardiovascular pathology

“…Имеются данные о кардиотоксическом эффекте абакавира с формированием кардиомиопатии через 19-24 месяца применения [47]. Абакавир инициирует развитие сосудистого воспаления -ведущего пускового механизма тромбоза и атеросклеротической бляшки [48].…”