In a large-scale global study, exploratory analysis finds that abacavir increases the risk of cardiovascular disease in a large-scale trial

Media Advisory

Tuesday July 23, 2020

The findings add to the body of knowledge about risk factors associated with cardiovascular disease in people living with HIV.

Transmission electron micrograph showing HIV-1 particles (teal blue) budding and replicating from part of a chronically infected H9 cell. The image was captured by the NIAID Integrated Research Center at Fort Detrick, Maryland.NIAID

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According to an exploratory study of a large international trial funded primarily by the National Institutes of Health and funded by abacavir as an antiretroviral (ARV), past or current use of abacavir was associated with an increased risk of serious adverse cardiovascular events. Other antiretroviral drugs included in the study did not have elevated MACE rates. These findings will be discussed at the International AIDS Conference 2024 in Munich.

In the randomized trial to prevent HIV-related vascular events (REPRIEVE), 7769 HIV-positive participants from 12 different countries were recruited. Daily use of statins to lower cholesterol was shown to be effective. Reduces the risk of serious adverse cardiovascular events such as stroke and heart attack by more than a third. The REPRIEVE team conducted statistical analyses to determine whether certain ARVs are associated with MACE in participants with low to moderate cardiovascular risk. ARVs selected for analysis included abacavir (tenofovir), zidovudine (zidovudine), stavudine, and drugs belonging to a class of protease inhibitors. They were all taken as part of multi-drug regimens.

A total of 22 % reported exposure to abacavir. 86 % had been exposed to tenofovir. 49 % had been exposed to zidovudine/stavudine. 47% of participants were taking PIs. At study entry, 13 % of participants were taking abacavir. 61 % had been taking tenofovir. 10 % were receiving zidovudine/stavudine. 26% used PIs. Investigators found that participants who had used abacavir in the past or currently had a higher risk of MACE than those who had not. Past or current ARV use had no effect on MACE risk. Similarly, administration of ARVs as part of an ARV protocol or the combination of ARVs with other drug classes had no impact on the risk of MACE.

The authors say these findings are consistent with other studies that have also found an increased risk of cardiovascular disease with abacavir. The authors suggest further research is needed to understand the elevated risk observed in this study and how it should be considered in the context of known cardiovascular risk factors such as diabetes, dyslipidemia or hypertension in HIV-positive people.

You can find more information about the REPRIEVE study on ClinicalTrials.gov by searching for the identifier. NCT02344290.

Refer to the following:

CJ Fichtenbaum The et allIn the REPRIEVE study, abacavir was associated with an elevated risk of cardiovascular events. International AIDS Conference. Friday, July 27, 2024.

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Sarah Read, MD, deputy director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases (NIH), is available to discuss this research.

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