Abstract 21178: Abacavir-based Antiretroviral Therapy is Associated with Long-term Increase incidence of Cardiovascular Events in HIV Patients with Presumable Cardiovascular Disease
Background: Antiretroviral therapy (ARV) with Abacavir is postulated to be associated with increased cardiovascular (CV) risk. We evaluated the long-term incidence of major adverse CV events (MACE) in patients with suspected CV disease and HIV infection treated with Abacavir (Ab).
Methods: 286 HIV-infected patients, admitted with ACS, were included in this study. Patients were assigned to one of 3 groups: Group A (ARV with Ab), group B (ARV without Ab) and group C (No ARV). A composite endpoint of CV readmission, MACE and all-cause mortality was assessed at 18, 36, 54 and 72 months (5.4 years) in the three cohorts.
Results: A total of 286 patients were included in the final analysis, 30 for group A, 169 for group B and 87 for group C. Baseline characteristics among the three groups were similar including history of CAD, diabetes, hypertension, hyperlipidemia and baseline LVEF. Mortality free survival was significantly higher in group B (93%) when compared to groups A (78%) and C (56%, p <0.0001). Using Cox regression, the presence of CAD (HR=3.4, 95%CI: 1.57-7.6; p=0.002), diabetes (HR=2.1, 95%CI: 1.03-4.57; p=0.04), and ARV with Ab (HR=2.2, 95%CI: 1.39-3.05; p=0.0003) were predictors for worse outcome. These observations were detected as early as 180 days (Figure).
Conclusion: Abacavir-based ARV is associated with a long-term increase incidence of CV events and all-cause mortality in patients with HIV infection with presumable CV disease. The mechanisms involving this association require further research.
- © 2010 by American Heart Association, Inc.