Cardiovascular Disease Risk Markers in HIV-Infected Patients Receiving Abacavir or Tenofovir

Rajesh T. Gandhi, MD

In patients randomly assigned to receive abacavir or tenofovir, there was no difference in flow-mediated vasodilation or in inflammatory or coagulation biomarkers.

In 2008, the observational DAD study suggested a link between recent abacavir use and increased risk for myocardial infarction (MI; NEJM JW AIDS Clin Care Apr 14 2008). Since that time, multiple studies have examined this association, with some finding a link and others — including a large meta-analysis conducted by the FDA — finding no connection (NEJM JW AIDS Clin Care Jun 27 2011). To shed light on this controversy, investigators (with support from abacavir's manufacturer) conducted a cross-sectional analysis of cardiovascular disease risk markers in HIV-infected adults who had been randomly assigned — through previous participation in a clinical trial — to receive either abacavir or tenofovir for initial therapy.

Forty-six patients receiving abacavir and 72 receiving tenofovir were recruited for the study. (Although the investigators intended to have about 70 patients per group, there were too few patients who were receiving abacavir at the study sites to reach the target enrollment.) The clinical characteristics of the groups were similar, except that those receiving abacavir had a slightly longer duration of antiretroviral therapy than those receiving tenofovir (mean, 4.0 vs. 3.6 years) and were more likely to be receiving protease inhibitors (67% vs. 48%).

Comparing the abacavir and tenofovir groups, the investigators found:

• Flow-mediated vasodilation, a measurement of endothelial function and a surrogate marker for cardiovascular disease, was similar.
• C-reactive protein levels and the proportions of patients with detectable interleukin-6 or D-dimer levels were similar.
• LDL and HDL cholesterol levels were similar; triglyceride levels were lower in the tenofovir group (mean, 115 vs. 174 mg/dL).

Citation(s):

Wohl DA et al. Comparison of cardiovascular disease risk markers in HIV-infected patients receiving abacavir and tenofovir: The nucleoside inflammation, coagulation and endothelial function (NICE) study. Antivir Ther 2014; 19:141.