HIV Drug Combo Elicits Comparable Myocardial Infarction, CAD Risks

Abacavir use is not associated with an increased risk for myocardial infarction (MI) or coronary artery disease (CAD) in patients with human immunodeficiency virus (HIV), according to a recent meta-analysis.

Findings were presented at ID Week, which took place from October 4 to 8, 2017, in San Diego, California.
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Some previous studies have indicated a potential relationship between abacavir use and MI. However, the results have been inconsistent.

For their analysis, the researchers combined summary data from 52 Phase II-IV randomized controlled trials (RCTs) and aggregate data from 14 new RCTs. Patients had been randomly assigned to receive either abacavir-containing combination antiretroviral therapy (cART) or other cARTs, or abacavir had been prescribed as a background medication.

Primary analyses included ABC-randomized trials that focused on MI and conducted follow-up for 48 weeks or longer, and secondary analyses included shorter duration trials and non-abacavir randomized trials, and estimated incidence rates and relative risks (RR) for MI and CAD.

Results indicated that 13,119 adults had received abacavir-containing cART, while 7350 had not. The exposure-adjusted incidence rate for MI was 1.5 per 1000 person-years (PY) in those on abacavir and 2.18 per 1000 PY in those who had not received abacavir, with a RR of 0.69. The RR for MI was 0.69 when shorter duration studies were included and was 0.83 when abacavir non-randomized studies were included.

The researchers calculated an incidence rate for CAD of 2.9 per 1000 PY in patients on abacavir and 4.69 per 1000 PY in those who had not received abacavir, with a RR of 0.62. When studies of less than 48 weeks were included, the incidence rate for CAD was 2.96 per 1000 PY in those on abacavir and 4.65 per 1000 PY in those who had not received abacavir, with an RR of 0.64.

“This expanded meta-analysis found comparable [incidence rates] for MI and CAD among [abacavir]-exposed and unexposed subjects, suggesting no increased risk for MI or CAD following [abacavir] exposure,” the researchers concluded. “These findings provide further evidence against an association between MI and CAD and [abacavir] exposure in this clinical trial population. Modifiable risk factors for MI and CAD should be addressed when prescribing ART for treatment of HIV.”

—Christina Vogt

Reference:

Nan C, Shaefer MS, Urbaityte R, et al. Abacavir use and risk for myocardial infarction and coronary artery disease: updated meta-analysis of data from clinical trials. Paper presented at: ID Week 2017; October 4-8, 2017; San Diego, CA. https://idsa.confex.com/idsa/2017/webprogram/Paper65629.html.