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Ziagen and MI
May 7, 2008

Anything new since the recent study came out about a possible link between abacavir and MI?

Response from Dr. Moyle

The study you refer to, the DAD, was recently published in The Lancet medical journal. The data came from a single study that looked at a large group of people with HIV followed over time. It is a well-known study, but there may be biases in this type of cohort study that can be hard to identify and which may influence its results. Additionally, the finding is, so far, an isolated one. There has never before been a link between abacavir and heart attacks and there is no obvious mechanism to explain such a link. Glaxo, abacavir's manufacturer has found no such link in their database which tracks people taking abacavir versus other medications in randomized trials. Importantly, in the DAD study, while there was an increased risk of heart attacks during abacavir treatment in this study, the rate of heart attacks was low. Therefore, abacavir increased the risk of something that remained pretty rare. Also, they have not reported data with tenofovir, the main alternative to abacavir, so far. So abacavir is kind of a known known and tenofovir a known unknown (sorry, Mr. Rumsfeld).

The data need to be considered carefully alongside existing data and information from other large cohorts of HIV+ persons that will hopefully emerge. Emphasis in managing heart attack risk should continue to be placed on reducing traditional risk factors for heart disease, such as smoking, diet and obesity, and abnormal lipids.

Best Wishes,

Dr. Moyle (with assistance from Dr. Wohl's expert forum)

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