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Abacavir use is associated with increased prothrombin conversion.

Qiuting Yan1,2, Shengshi Huang1,2, Wouter van der Heijden3

  • 1Department of Functional Coagulation, Synapse Research Institute, Maastricht, Netherlands.

Frontiers in Immunology
|May 1, 2023
PubMed
Summary
This summary is machine-generated.

Abacavir (ABC) use in people living with HIV (PLHIV) significantly increases thrombin generation kinetics, potentially explaining cardiovascular disease (CVD) risk. This effect stems from accelerated prothrombin conversion, not altered clotting factor levels.

Keywords:
HIVabacavircoagulationthrombin dynamicsthrombin generation

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Area of Science:

  • Pharmacology
  • Cardiovascular Medicine
  • Virology

Background:

  • Debate exists on abacavir (ABC) increasing cardiovascular disease (CVD) risk in people living with HIV (PLHIV).
  • Previous research linked ABC-containing regimens to increased thrombin generation (TG).

Purpose of the Study:

  • To investigate the mechanistic basis of increased thrombin generation in PLHIV on ABC.
  • To differentiate between procoagulant and anticoagulant pathway involvement in ABC-associated TG.

Main Methods:

  • Cross-sectional study of 208 virally suppressed PLHIV on various antiretroviral regimens.
  • Calibrated Automated Thrombinography used for thrombin generation and dynamics analysis.
  • Comparison between ABC-containing, tenofovir disoproxil fumarate (TDF)-containing, and other regimens.

Main Results:

  • Significantly increased total prothrombin conversion and maximum conversion rate in PLHIV on ABC regimens.
  • No significant differences in pro- or anticoagulant factor levels between ABC and non-ABC groups.
  • Elevated Von Willebrand Factor (VWF) markers in PLHIV overall, but not differing by ABC treatment.

Conclusions:

  • Abacavir intensifies thrombin generation by accelerating prothrombin conversion kinetics, not by altering clotting factor levels.
  • This kinetic shift may contribute to the debated increased CVD risk in PLHIV on ABC.
  • Further research is needed to fully elucidate the ABC-CVD link.