Study Links HIV Drug Abacavir to Higher Cardiovascular Risk

On July 23, 2024, an analysis from a significant international clinical trial highlighted that the antiretroviral drug abacavir is linked to an increased risk of major adverse cardiovascular events (MACE) in individuals with HIV. This trial, known as the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), was chiefly funded by the National Institutes of Health (NIH) and enrolled 7,769 participants living with HIV from 12 different countries. The detailed findings will be unveiled at the 2024 International AIDS Conference in Munich, Germany.

The REPRIEVE trial primarily aimed to evaluate whether daily use of a cholesterol-controlling statin could reduce the risk of cardiovascular incidents such as heart attacks and strokes. Results demonstrated that the statin indeed decreased the risk of these events by over one-third among the participants. In addition to this primary objective, the study team also investigated the potential link between certain antiretroviral drugs (ARVs) and MACE risk. The ARVs scrutinized in this analysis included abacavir, tenofovir, zidovudine, stavudine, and a class of drugs known as protease inhibitors (PIs). These drugs were all components of multi-drug antiretroviral therapy (ART) regimens.

The participant data revealed that 22% had previously used abacavir, 86% had been exposed to tenofovir, 49% to zidovudine or stavudine, and 47% to PIs. At the commencement of the study, 13% were on abacavir, 61% on tenofovir, 10% on zidovudine or stavudine, and 26% on PIs. Through their analysis, researchers found that both prior and current use of abacavir significantly heightened the risk of MACE by 50% and 42%, respectively, compared to those never exposed to the drug. In contrast, the usage of other ARVs did not show any association with an increased MACE risk. Moreover, the combination of different ARV drug classes within an ART regimen did not alter the elevated MACE risk for those with prior or ongoing abacavir exposure.

The investigators noted that these results are consistent with previous studies that also linked abacavir with a higher risk of cardiovascular disease. They emphasized the need for further research to understand the underlying reasons for this increased risk and how these findings should be interpreted alongside known cardiovascular risk factors, such as dyslipidemia, diabetes, and hypertension, particularly in people living with HIV.

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