Evidence is conflicting about the association of abacavir
use and cardiovascular disease (CVD) among HIV-infected individuals. Prior
studies may have been biased by the preferential initiation or continuation of
abacavir in patients with renal dysfunction.
We conducted a cohort study in Kaiser Permanente California
during 1998-2011, following HIV-infected adults initiating antiretroviral
therapy (ART) until the earliest of CVD (i.e., coronary heart disease or
ischemic stroke), health plan disenrollment, death, or end of study. We used
inverse probability weighting to fit marginal structural models to estimate
hazard ratios (HRs) for CVD comparing regimens with and without abacavir.
Propensity score models included demographics, HIV-specific factors, and CVD
risk factors, including alcohol/drug use, smoking, overweight/obesity,
diabetes, lipid-lowering and hypertension therapy, and renal dysfunction (i.e.,
estimated glomerular filtration rate <60 mL/min/1.73 m2).
Among 8154 subjects, 178 had ≥1 CVD event, with 24/704
(3.4%) in the abacavir group and 154/7450 (2.1%) in the group initiating
regimens without abacavir. Abacavir users had more renal dysfunction at ART
initiation (7.0% vs. 3.3%, P<0.001). Compared with patients initiating
regimens without abacavir, abacavir users had a 2.2-fold higher risk of CVD in
intention-to-treat analysis, a
2.7-fold higher risk when remaining on their initial regimens for ≥1 year, and a 2.1-fold higher risk in per-protocol analysis.
Abacavir was associated with an over two-fold increased risk
of CVD, which was not explained by renal dysfunction or other CVD risk factors.
Purchase full article at: http://goo.gl/phst6p
By:
- 1Kaiser Permanente Northern California, Oakland, CA 2Kaiser Permanente Southern California, Pasadena, CA 3Kaiser Permanente Northern California, Hayward, CA 4Kaiser Permanente Southern California, Los Angeles, CA 5Kaiser Permanente Mid-Atlantic States, Rockville, MD.
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