The REPRIEVE trial, a large randomized clinical trial of people with HIV, has revealed a concerning association between abacavir use and an increased risk of cardiovascular events. The study found that both former and current users of abacavir experienced an approximate 50% increase in the risk of heart attack, stroke, and other major cardiovascular events. This finding, presented at the 25th International Conference on AIDS in Munich, Germany, reinforces previous data suggesting a potential cardiovascular risk associated with the drug.
Study Details and Findings
The REPRIEVE trial enrolled participants between 2015 and 2019, with an average profile as follows: 50 years of age, 69% male, 31% female, a median CD4+ count of 621 cells/mm3, and 88% with an undetectable viral load due to antiretroviral therapy (ART). Notably, 36% of participants had high blood pressure. Researchers found that 9% of participants had used abacavir in the past for an average of three years, while 13% were currently taking it at the time of enrollment.
After considering various factors, including traditional cardiovascular risks, sex, ethnicity, smoking, high blood pressure, substance use, CD4+ cell count, kidney health, and blood sugar levels, the researchers observed the significant increase in cardiovascular event risk among abacavir users. This is particularly concerning because the participants in REPRIEVE were characterized as having a "low-to-moderate risk" of cardiovascular disease.
Implications for Clinical Practice
The findings from the REPRIEVE trial are likely to further discourage the use of abacavir in HIV treatment. While an analysis by the FDA had previously not found such an association with abacavir, HIV treatment guidelines have generally recommended cautious use, especially in individuals at high risk for cardiovascular disease. The growing body of evidence, including this recent data, may accelerate the shift away from abacavir-containing regimens.
Prior Research and Context
Concerns regarding abacavir and cardiovascular risk initially surfaced in 2008, with observational studies suggesting a potential link. Although these studies could not provide definitive results, the possibility of cardiovascular risk led to a decline in abacavir use over the years. The REPRIEVE trial adds further weight to these concerns, highlighting the importance of careful consideration when selecting antiretroviral therapies, particularly in the context of cardiovascular health.
