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abacavir and heart attack risk
Aug 29, 2014

Do you have any conerns with abacavir and heart health? I hear a study is coming out soon to answer this? I posted about switching to triumeq, but have some concerns about heart health equally when comparing to kidney and bone problems of other meds. ( tenovifir)

Response from Dr. Young

Hello and thanks for posting.

[Disclosure: I've received research funding from the makers of both abacavir (Viiv Healthcare) and tenofovir (Gilead Sciences) and the US Centers for Disease Control and Prevention.]

We've been hearing about the possible link between abacavir and heart disease risk for years- based primarily on the analysis from one clinical group in Europe (called D:A:D). Since then, multiple large academic groups, including the NIH's AIDS Clinical Trials Group, the US Centers for Disease Control, the Canadian Observational Cohort, the drug manufacturer, Viiv Healthcare, have all looked for and failed to find any statistical correlation.

You've alluded to yet another analysis, I think, from the North American ACCORD group, which is a mega cohort of large studies, from across the continent. I don't think necessarily that this will add much to the discussion, or further "answer" the question.

Of course, last week's FDA approval of Triumeq- a US government panel-recommended combo pill that includes abacavir- will challenge the market share of every other non-abacavir-containing (ie., tenofovir-containing) combo pill will only add to the commercial heat, bias and the noise surrounding this topic.

Overall, there isn't solid evidence at all that abacavir causes heart problems. Rather, the preponderance of studies actually suggest the contrary- that the risk isn't there. Even if such abacavir risk exists, it must only be measured in one, but not all populations of people (hence the discrepancy between North American and European studies), or that any added risk is insignificant compared with other risk factors (like diabetes, high blood pressure, hepatitis infection or smoking) in the study populations.

By contrast, there is no debate as to whether tenofovir is associated with increased risk of kidney and bone toxicity. This has been established in study after study.

In the end though, what's critical is to appreciate that HIV medications in general (and appropriately selected and monitored) are incredibly well tolerated and safe. These are cups that are "99%" full. I usually try to be very mindful of the 1%, but make sure that I'm not neglecting more significant health risks in my patients, like mental health, diabetes, high blood pressure, hepatitis or tobacco.

Hope that helps, BY



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