Exploratory Analysis Highlights Elevated Risk

An exploratory analysis from a large international clinical trial, primarily funded by the National Institutes of Health (NIH), has found that the antiretroviral drug (ARV) abacavir is associated with an increased risk of major adverse cardiovascular events (MACE) in individuals with HIV. The findings, which will be presented at the 2024 International AIDS Conference (AIDS 2024) in Munich, Germany, suggest that abacavir users face a significantly higher risk of cardiovascular issues compared to those who do not use this drug. No similar increase in MACE risk was observed with other ARVs included in the study.

Transmission electron micrograph of HIV-1 virus particles (teal) budding and replicating from a segment of a chronically infected H9 cell (tan). Image captured at the NIAID Integrated Research Facility in Fort Detrick, Maryland.NIAID

Details of the REPRIEVE Study

The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) involved 7,769 participants from 12 countries. The trial demonstrated that daily use of a cholesterol-lowering statin significantly reduced the risk of major adverse cardiovascular events, such as heart attacks and strokes, by over one third. The study also analyzed whether specific ARVs were linked to MACE risk. The ARVs studied included abacavir, tenofovir, zidovudine, stavudine, and various protease inhibitors (PIs). All participants were on multi-drug ART regimens and had low-to-moderate cardiovascular disease risk at the study’s outset.

Findings and Implications

Of the study participants, 22% reported prior use of abacavir, 86% had used tenofovir, 49% had used zidovudine or stavudine, and 47% had used PIs. At the beginning of the study, 13% were taking abacavir, 61% were on tenofovir, 10% were using zidovudine or stavudine, and 26% were on PIs. The analysis revealed that participants with prior or current use of abacavir had a 50% and 42% increased risk of MACE, respectively, compared to those with no abacavir exposure. No similar increase in MACE risk was observed with the other ARVs. The study's authors note that these findings corroborate earlier research linking abacavir with heightened cardiovascular risk and emphasize the need for further investigation into how these results interact with other known cardiovascular risk factors, such as dyslipidemia, diabetes, and hypertension.

Highlights

• An exploratory analysis links the ARV abacavir to increased cardiovascular risk.
• The REPRIEVE trial found that abacavir users had a 50% to 42% higher risk of major adverse cardiovascular events.
• No similar risk increase was observed for other antiretroviral drugs studied.
• The findings align with previous research and suggest the need for more detailed studies on abacavir's cardiovascular effects.

Reference

CJ Fichtenbaum et al. "Abacavir is associated with elevated risk for cardiovascular events in the REPRIEVE trial." International AIDS Conference. Friday, July 26, 2024.

Data Source: https://www.nih.gov/news-events/news-releases/exploratory-analysis-associates-hiv-drug-abacavir-elevated-cardiovascular-disease-risk-large-global-trial