No risk of myocardial infarction associated with initial antiretroviral treatment containing abacavir: short and long-term results from ACTG A5001/ALLRT.

TitleNo risk of myocardial infarction associated with initial antiretroviral treatment containing abacavir: short and long-term results from ACTG A5001/ALLRT.
Publication TypeJournal Article
Year of Publication2011
AuthorsRibaudo HJ, Benson CA, Zheng Y, Koletar SL, Collier AC, Lok JJ, Smurzynski M, Bosch RJ, Bastow B, Schouten JT
Corporate AuthorsACTG A5001/ALLRT Protocol Team
JournalClin Infect Dis
Volume52
Issue7
Pagination929-40
Date Published2011 Apr 1
ISSN1537-6591
KeywordsAdult, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Dideoxynucleosides, Female, HIV Infections, Humans, Male, Middle Aged, Myocardial Infarction, Risk Assessment
Abstract

BACKGROUND: Observational and retrospective clinical trial cohorts have reported conflicting results for the association of abacavir use with risk of myocardial infarction (MI), possibly related to issues that may bias estimation of treatment effects, such as time-varying confounders, informative dropout, and cohort loss due to competing events.

METHODS: We analyzed data from 5056 individuals initiating randomized antiretroviral treatment (ART) in AIDS Clinical Trials Group studies; 1704 started abacavir therapy. An intent-to-treat analysis adjusted for pretreatment covariates and weighting for informative censoring was used to estimate the hazard ratio (HR) of MIs after initiation of a regimen with or without abacavir.

RESULTS: Through 6 years after ART initiation, 36 MI events were observed in 17,404 person-years of follow-up. No evidence of an increased hazard of MI in subjects using abacavir versus no abacavir was seen (over a 1-year period: P=.50; HR, 0.7 [95% confidence interval {CI}, 0.2-2.4]); over a 6-year period: P=.24; HR, 0.6 [95% CI, 0.3-1.4]); these results were robust over as-treated and sensitivity analyses. Although the risk of MI decreased over time, there was no evidence to suggest a time-dependent abacavir effect. Classic cardiovascular disease (CVD) risk factors were the strongest predictors of MI.

CONCLUSION: We find no evidence to suggest that initial ART containing abacavir increases MI risk over short-term and long-term periods in this population with relatively low MI risk. Traditional CVD risk factors should be the main focus in assessing CVD risk in individuals with human immunodeficiency virus infection.

DOI10.1093/cid/ciq244
Alternate JournalClin. Infect. Dis.
PubMed ID21427402
PubMed Central IDPMC3062545
Grant ListA1027658 / / PHS HHS / United States
A7901 / / PHS HHS / United States
A9327 / / PHS HHS / United States
A9413 / / PHS HHS / United States
AI 38855 / AI / NIAID NIH HHS / United States
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