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Recent abacavir use and incident cardiovascular disease in contemporary-treated people with HIV
Nadine Jaschinski1, Lauren Greenberg2, Bastian Neesgaard1
1CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Insights
Recent abacavir (ABC) use in people with HIV is linked to a higher risk of cardiovascular disease (CVD). This association persists even when accounting for cardiovascular and chronic kidney disease risk factors.
Area of Science:
- HIV Medicine
- Cardiovascular Epidemiology
- Pharmacovigilance
Background:
- Abacavir (ABC) is an antiretroviral medication used to treat HIV.
- Previous studies suggested a link between ABC and cardiovascular disease (CVD).
- Contemporary treatment guidelines and patient populations may influence this association.
Purpose of the Study:
- To assess if the association between abacavir (ABC) and cardiovascular disease (CVD) persists in a contemporary HIV-positive population.
- To determine if CVD or chronic kidney disease (CKD) risk influences the initiation of ABC therapy.
- To evaluate the association between recent ABC use and the incidence of CVD events.
Main Methods:
- A multinational cohort of people with HIV (RESPOND) was analyzed.
- Participants were followed from 2012 to 2019 for CVD events (myocardial infarction, stroke, invasive cardiovascular procedures).
- Logistic and negative binomial regression models were used to assess ABC initiation and CVD risk, adjusting for confounders.
Main Results:
- Of 29,340 individuals, 34% recently used ABC.
- Higher CKD risk was associated with increased odds of starting ABC, while higher CVD risk was associated with lower odds.
- Recent ABC use was associated with a 40% increased incidence rate of CVD events (IRR 1.40 [1.20-1.64]).
Conclusions:
- A significant association between recent abacavir use and cardiovascular disease incidence was confirmed in a contemporary HIV-positive population.
- This association was not explained by preferential prescribing of ABC in individuals with higher CVD or CKD risk.
- The findings highlight the continued need for cardiovascular risk monitoring in individuals using abacavir.
Objective:
Assessing whether the previously reported association between abacavir (ABC) and cardiovascular disease (CVD) remained amongst contemporarily treated people with HIV.
Design:
Multinational cohort collaboration.
Methods:
RESPOND participants were followed from the latest of 1 January 2012 or cohort enrolment until the first of a CVD event (myocardial infarction, stroke, invasive cardiovascular procedure), last follow-up or 31 December 2019. Logistic regression examined the odds of starting ABC by 5-year CVD or chronic kidney disease (CKD) D:A:D risk score. We assessed associations between recent ABC use (use within the past 6 months) and risk of CVD with negative binomial regression models, adjusted for potential confounders.
Results:
Of 29 340 individuals, 34% recently used ABC. Compared with those at low estimated CVD and CKD risks, the odds of starting ABC were significantly higher among individuals at high CKD risk [odds ratio 1.12 (95% confidence interval = 1.04-1.21)] and significantly lower for individuals at moderate, high or very high CVD risk [0.80 (0.72-0.88), 0.75 (0.64-0.87), 0.71 (0.56-0.90), respectively]. During 6.2 years of median follow-up (interquartile range; 3.87-7.52), there were 748 CVD events (incidence rate 4.7 of 1000 persons-years of follow up (4.3-5.0)]. The adjusted CVD incidence rate ratio was higher for individuals with recent ABC use [1.40 (1.20-1.64)] compared with individuals without, consistent across sensitivity analyses. The association did not differ according to estimated CVD (interaction P = 0.56) or CKD ( P = 0.98) risk strata.
Conclusion:
Within RESPOND's contemporarily treated population, a significant association between CVD incidence and recent ABC use was confirmed and not explained by preferential ABC use in individuals at increased CVD or CKD risk.
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