The trial found that use of a particular drug in HIV patients significantly increased the risk of major cardiovascular events, while other similar drugs did not show the same risk.
Summary: A study funded by the National Institutes of Health (NIH) has found that the antiretroviral drug abacavir is linked to a higher risk of major adverse cardiovascular events in people with HIV. This finding comes from the REPRIEVE trial, which involved 7,769 participants from 12 countries. The study revealed that current or previous use of abacavir significantly increased the risk of heart attacks and strokes, whereas other antiretroviral drugs did not show the same association.
Key Takeaways:
- Elevated Cardiovascular Risk: The study found that current or previous use of abacavir in HIV patients is associated with a significantly higher risk of major adverse cardiovascular events, such as heart attacks and strokes.
- Comparison with Other Drugs: Other antiretroviral drugs included in the study, such as tenofovir, zidovudine, stavudine, and protease inhibitors, were not associated with an increased risk of cardiovascular events.
- Need for Further Research: The findings align with previous studies suggesting an elevated cardiovascular risk with abacavir, highlighting the need for more research to understand the underlying causes and implications for managing cardiovascular risk in HIV patients.
Current or previous use of the antiretroviral drug abacavir was associated with an elevated risk of major adverse cardiovascular events in people with HIV, according to an exploratory analysis from a large international clinical trial primarily funded by the National Institutes of Health (NIH).
There was no elevated major adverse cardiovascular events risk for the other antiretroviral drugs included in the analysis. The findings will be presented at the 2024 International AIDS Conference (AIDS 2024) in Munich, Germany.
REPRIEVE Study
The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) enrolled 7,769 study participants with HIV from 12 countries that found daily use of a cholesterol-fighting statin drug reduced the risk of major adverse cardiovascular events, such as heart attacks and strokes by more than one third.
The REPRIEVE study team also performed statistical analyses to assess whether select antiretroviral drugs were associated with major adverse cardiovascular events risk among study participants, all of whom had low-to-moderate cardiovascular disease risk. The antiretroviral drugs selected for analysis had previously been linked to cardiovascular risk and included abacavir, tenofovir, zidovudine, stavudine, and drugs from a class called protease inhibitors. All were taken as part of multi-drug antiretroviral therapy regimens.
Overall, 22% of study participants reported prior exposure to abacavir, 86% to tenofovir, 49% to zidovudine or stavudine, and 47% to protease inhibitors. At study entry, 13% of participants were taking abacavir, 61% were taking tenofovir, 10% were taking zidovudine or stavudine, and 26% were taking protease inhibitors.
In the investigators’ analyses, participants with prior and current use of abacavir had a 50% and 42% elevated risk of major adverse cardiovascular events, respectively, compared to participants with no abacavir exposure.
Former or current use of other antiretroviral drugs was not associated with any change in major adverse cardiovascular events risk, and the co-administration of common antiretroviral drug classes as part of an antiretroviral therapy regimen did not impact the elevated major adverse cardiovascular events risk among participants with current or prior abacavir exposure.
Findings Align With Previous Studies
According to the authors, these findings align with previous studies that also identified an elevated cardiovascular disease risk associated with abacavir. They suggest that more research is needed to better understand the increased risk observed in this analysis, including how these findings should be considered in the context of known cardiovascular disease risk factors, such as dyslipidemia, diabetes, and hypertension, for people with HIV.
Photo caption: Transmission electron micrograph of HIV-1 virus particles (teal) budding and replicating from a segment of a chronically infected H9 cell (tan).
Photo credit: Image captured at the NIAID Integrated Research Facility in Fort Detrick, Maryland.