Use of Abacavir and Risk of Cardiovascular Disease Among HIV-Infected Individuals

Marcus, Julia L.; Neugebauer, Romain; Leyden, Wendy A.; Chao, Chun; Xu, Lanfang; Quesenberry, Charles P.; Klein, Daniel B.; Towner, William; Horberg, Michael A.; Silverberg, Michael J.

doi:10.1097/qai.0000000000000881

Cited by 77 publications

(44 citation statements)

References 53 publications

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“…Previously, there has been limited literature regarding the association of ARVs with CVD, including conflicting data regarding the increased risk of CVD with specific classes of ARVs, most of which focused on atherosclerosis or coronary artery disease . However, despite well‐known associations of HIV infection with HF and cardiomyopathies, few studies have evaluated ARVs and HF .…”

Section: Discussionmentioning

confidence: 99%

Association of Tenofovir Use With Risk of Incident Heart Failure in HIV‐Infected Patients

Chen

Scherzer

Hsue

et al. 2017

JAHA

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BackgroundThe antiretroviral medication, tenofovir disoproxil fumarate (TDF), is used by most human immunodeficiency virus–infected persons in the United States despite higher risks of chronic kidney disease. Although chronic kidney disease is a strong risk factor for heart failure (HF), the association of TDF with incident HF is unclear.Methods and ResultsWe identified 21 435 human immunodeficiency virus–infected patients in the United States Veterans Health Administration actively using antiretrovirals between 2002 and 2011. We excluded patients with a prior diagnosis of HF. TDF was analyzed categorically (current, past, or never use) and continuously (per year of use). Proportional hazards regression and fully adjusted marginal structural models were used to determine the association of TDF exposure with risk of incident HF after adjustment for demographic, human immunodeficiency virus–related, and cardiovascular risk factors. During follow‐up, 438 incident HF events occurred. Unadjusted 5‐year event rates for current, past, and never users of TDF were 0.9 (95%CI 0.7‐1.1), 1.7 (1.4‐2.2), and 4.5 (3.9‐5.0), respectively. In fully adjusted analyses, HF risk was markedly lower in current TDF users (HR=0.68; 95%CI 0.53‐0.86) compared with never users. Among current TDF users, each additional year of TDF exposure was associated with a 21% lower risk of incident HF (95%CI: 0.68‐0.92). When limited to antiretroviral‐naive patients, HF risk remained lower in current TDF users (HR=0.53; 95%CI 0.36‐0.78) compared to never users.ConclusionsAmong a large national cohort of human immunodeficiency virus–infected patients, TDF use was strongly associated with lower risk of incident HF. These findings warrant confirmation in other populations, both with TDF and the recently approved tenofovir alafenamide fumarate.

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Section: Discussionmentioning

confidence: 99%

Association of Tenofovir Use With Risk of Incident Heart Failure in HIV‐Infected Patients

Chen

Scherzer

Hsue

et al. 2017

JAHA

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“…1,7,34,35 More studies have now been published describing the association, 47–49 but the data remain inconclusive. For now, abacavir should be used with caution in patients who have or who are at high risk of cardiovascular disease.…”

Section: Recommended Initial Regimensmentioning

confidence: 99%

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Günthard

Saag

Benson

et al. 2016

JAMA

567

313

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“…20, 49–58 Most recently, a study from Kaiser evaluated patients initiating regimens with and without abacavir and found abacavir users to have a more than two-fold increased risk of CVD, after accounting for traditional CVD risk factors including renal dysfunction. 59 Updated data from the D:A:D cohort through early 2013 continued to show a nearly two-fold increased risk of MI with abacavir, with no difference in the relative risk comparing time periods before and after the initial abacavir publication. 60 …”

Section: Risk Factors For Ischemic Heart Disease In Hivmentioning

confidence: 99%

Epidemiology of ischemic heart disease in HIV

Triant

Grinspoon

2017

Current Opinion in HIV and AIDS

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Purpose of review The purpose of this review is to summarize and synthesize recent data on the risk of ischemic heart disease (IHD) in HIV-infected individuals. Recent findings Recent studies in the field demonstrate an increasing impact of cardiovascular disease (CVD) on morbidity and mortality in HIV relative to AIDS-related diagnoses. Studies continue to support an approximately 1.5 to 2-fold increased risk of IHD conferred by HIV, with specific risk varying by gender and virologic/immunologic status. Risk factors include both traditional CVD risk factors and novel, HIV-specific factors including inflammation and immune activation. Specific antiretroviral therapy (ART) drugs may increase CVD risk, yet the net effect of ART with viral suppression is beneficial with regards to CVD risk. Management of cardiovascular risk and prevention of CVD is complex, because current general population strategies target traditional CVD risk factors only. Extensive investigation is being directed at developing tailored CVD risk prediction algorithms and interventions to reduce CVD risk to HIV. Summary Increased IHD risk is a significant clinical and public health challenge in HIV. The development and application of HIV-specific interventions to manage CVD risk factors and reduce CVD risk will improve the long-term health of this aging population.

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Use of Abacavir and Risk of Cardiovascular Disease Among HIV-Infected Individuals

Abstract: Abacavir was associated with an over 2-fold increased risk of CVD, which was not explained by renal dysfunction or other CVD risk factors.

Cited by 77 publications

References 53 publications

Association of Tenofovir Use With Risk of Incident Heart Failure in HIV‐Infected Patients

Association of Tenofovir Use With Risk of Incident Heart Failure in HIV‐Infected Patients

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Epidemiology of ischemic heart disease in HIV

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