TY - JOUR
T1 - Abacavir use and risk of acute myocardial infarction and cerebrovascular events in the highly active antiretroviral therapy era
AU - Bedimo, Roger J.
AU - Westfall, Andrew O.
AU - Drechsler, Henning
AU - Vidiella, Gabriela
AU - Tebas, Pablo
N1 - Funding Information:
Potential conflicts of interest. R. B. has received grant support from Tibotec Therapeutics and Merck; has been a consultant for Tibotec Therapeutics, Abbott Sciences, Gilead Sciences, and Merck; and has received payment for lectures from Merck and EMD Serono. P. T. has received grant support from VGX, Tibotec, Gilead, Bristol Myers Squibb, Tobira, Merck, VGX, VIRxSYS, and Sangamo. All other authors: no conflicts.
PY - 2011/7/1
Y1 - 2011/7/1
N2 - Background. Some studies have suggested that exposure to antiretroviral therapy (ART) with abacavir is associated with an increased risk of acute myocardial infarction (AMI).Methods.Using the Veterans Health Administration's Clinical Case Registry we calculated the risk of AMI and cerebrovascular events (CVA) associated with the cumulative use of abacavir and other nucleoside combinations. We also evaluated the impact of pre-existing chronic kidney disease on the selection of abacavir versus tenofovir in the last recorded ART regimen, and on highly active antiretroviral therapy-associated AMI and CVA risks.Results.A total of 19,424 human immunodeficiency virus-infected patients contributed 76,376 patient-years of follow. After adjusting for age, hypercholesterolemia, hypertension, type 2 diabetes, and smoking, the hazard ratio (HR) for each year of abacavir use was 1.18 (95% confidence interval [CI],. 92-1.50; P =. 191) for AMI and 1.16 (95% CI,. 98-1.37; P =. 096) for CVA. Abacavir use was more common among patients with prior chronic kidney disease than was tenofovir use (12.46% versus 7.15%; P =. 0001), and chronic kidney disease was associated with a significantly higher risk of AMI (HR, 2.41; 95% CI, 1.73-3.36), and CVA (HR, 1.80; 95% CI, 1.44-2.24). Compared with patients who received neither tenofovir nor abacavir, patients who received tenofovir had lower risk of AMI (HR, 0.16; 95% CI,. 08-.33; P =. 0001) and CVA (HR, 0.22; 95% CI,. 15-.32; P =. 001). Use of abacavir was associated with lower risk of CVA (HR, 0.60; 95% CI,. 45-.79).Conclusions.We observed no association between cumulative or current abacavir use and AMI or CVA. Abacavir use was more common than was tenofovir use among patients with prior chronic kidney disease, and chronic kidney disease independently predicted higher rates of AMI and CVA.
AB - Background. Some studies have suggested that exposure to antiretroviral therapy (ART) with abacavir is associated with an increased risk of acute myocardial infarction (AMI).Methods.Using the Veterans Health Administration's Clinical Case Registry we calculated the risk of AMI and cerebrovascular events (CVA) associated with the cumulative use of abacavir and other nucleoside combinations. We also evaluated the impact of pre-existing chronic kidney disease on the selection of abacavir versus tenofovir in the last recorded ART regimen, and on highly active antiretroviral therapy-associated AMI and CVA risks.Results.A total of 19,424 human immunodeficiency virus-infected patients contributed 76,376 patient-years of follow. After adjusting for age, hypercholesterolemia, hypertension, type 2 diabetes, and smoking, the hazard ratio (HR) for each year of abacavir use was 1.18 (95% confidence interval [CI],. 92-1.50; P =. 191) for AMI and 1.16 (95% CI,. 98-1.37; P =. 096) for CVA. Abacavir use was more common among patients with prior chronic kidney disease than was tenofovir use (12.46% versus 7.15%; P =. 0001), and chronic kidney disease was associated with a significantly higher risk of AMI (HR, 2.41; 95% CI, 1.73-3.36), and CVA (HR, 1.80; 95% CI, 1.44-2.24). Compared with patients who received neither tenofovir nor abacavir, patients who received tenofovir had lower risk of AMI (HR, 0.16; 95% CI,. 08-.33; P =. 0001) and CVA (HR, 0.22; 95% CI,. 15-.32; P =. 001). Use of abacavir was associated with lower risk of CVA (HR, 0.60; 95% CI,. 45-.79).Conclusions.We observed no association between cumulative or current abacavir use and AMI or CVA. Abacavir use was more common than was tenofovir use among patients with prior chronic kidney disease, and chronic kidney disease independently predicted higher rates of AMI and CVA.
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U2 - 10.1093/cid/cir269
DO - 10.1093/cid/cir269
M3 - Article
C2 - 21653308
AN - SCOPUS:79958833758
SN - 1058-4838
VL - 53
SP - 84
EP - 91
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 1
ER -