OAB3406LB Abacavir is associated with elevated risk for cardiovascular events in the REPRIEVE trial
Recommended Citation
Fichtenbaum CJ, Malvestutto CD, Watanabe MG, Smith ED, Ribaudo HJ, McCallum S, Fitch KV, Currier JS, Diggs M, Aberg JA, Lu MT, Valencia J, Gomez-Ayerbe C, Brar I, Madruga JV, Bloomfield GS, Douglas PS, Zanni MV, Grinspoon SK, and Investigators R. Abacavir is associated with elevated risk for cardiovascular events in the REPRIEVE trial. J Int AIDS Soc 2024; 27:89-90.
Document Type
Conference Proceeding
Publication Date
7-23-2024
Publication Title
J Int Aids Soc
Abstract
Background: Major adverse cardiovascular events (MACE) are more common in people with HIV (PWH). In REPRIEVE, pitavastatin reduced MACE by 35% among PWH with low-to-moderate traditional risk. We evaluated the role of prior and current use of antiretroviral agents (ART) on the development of MACE.
Methods: The trial enrolled PWH age 40–75 years on ART for at least 180 days, with a CD4 count >100 c/mm3 and low-moderate CVD risk. ART history was collected at baseline, including duration of exposure to select agents. Analyses in the REPRIEVE ITT population were performed for first MACE (including MI, TIA/stroke, revascularization, CV death), with median follow-up of 5.6 years. Cox proportional hazards models stratified by treatment group were used to account for treatment group differences. Effects of ART exposure were estimated in models unadjusted and adjusted for entry risk factors.
Results: Among 7,769 participants, 31.1% were natal female and 65.2% non-White. Median age was 50 years, LDL 108 mg/dL, 10-year ASCVD risk score 4.5%, CD4 621 cell/mm3 (447,826 c/mm3) with 88% having an HIV viral load <400 copies/mL. The median duration of ART use was 9.5 years (5.3,14.8 years) and varied by Country. Overall, 22% reported prior exposure to abacavir (ABC), 86% to Tenofovir (TDF), 49% to Thymidine analogs (AZT/d4T), and 47% to protease inhibitors (PIs). At study entry 13% were using ABC, 61% TDF, 10% AZT/d4T, and 26% PIs. Entry regimens included 2 NRTIs plus an NNRTI–47%, INSTI–25%, or a PI–19%. In adjusted analyses including the baseline regimen, both former and current use of ABC was associated with higher incidence of MACE (Figure). Former or current use of other ART agents was not associated with MACE (data not shown).
Conclusions: Former and current use of abacavir was associated with a higher incidence of subsequent major adverse cardiovascular events in the REPRIEVE trial.
Volume
27
First Page
89
Last Page
90
