Recent abacavir use and incident cardiovascular disease in contemporary treated people living with HIV.

Abstract

OBJECTIVE

Assessing whether the previously reported association between abacavir (ABC) and cardiovascular disease (CVD) remained amongst contemporarily treated people living with HIV (PLWH).

DESIGN

Multinational cohort collaboration.

METHODS

RESPOND participants were followed from latest of 01/01/2012 or cohort enrolment until the first of a CVD event (myocardial infarction [MI], stroke, invasive cardiovascular procedure [ICP]), last follow-up or 31/12/2019. Logistic regression examined 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 past six months) and risk of CVD with negative binomial regression models, adjusted for potential confounders.

RESULTS

Of 29,340 individuals, 34% recently used ABC. Compared to 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 median follow-up (interquartile range; 3.87-7.52), there were 748 CVD events (incidence rate [IR] 4.7/1000 persons-years of follow up [4.3-5.0]). The adjusted CVD IR ratio was higher for individuals with recent ABC use (1.40 [1.20-1.64]) compared to 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.