title: Abacavir use and risk of acute myocardial infarction and cerebrovascular events in the highly active antiretroviral therapy era.
abstract: BACKGROUND
  Some studies have suggested that exposure to antiretroviral therapy (ART) with abacavir is associated with an increased risk of acute myocardial infarction (AMI).
  
  
  METHODS
  Using the Veterans Health Administration's Clinical Case Registry we calculated the risk of AMI and cerebrovascular events (CVA) associated with the cumulative use of abacavir and other nucleoside combinations. We also evaluated the impact of pre-existing chronic kidney disease on the selection of abacavir versus tenofovir in the last recorded ART regimen, and on highly active antiretroviral therapy-associated AMI and CVA risks.
  
  
  RESULTS
  A total of 19,424 human immunodeficiency virus-infected patients contributed 76,376 patient-years of follow. After adjusting for age, hypercholesterolemia, hypertension, type 2 diabetes, and smoking, the hazard ratio (HR) for each year of abacavir use was 1.18 (95% confidence interval [CI], .92-1.50; P=.191) for AMI and 1.16 (95% CI, .98-1.37; P=.096) for CVA. Abacavir use was more common among patients with prior chronic kidney disease than was tenofovir use (12.46% versus 7.15%; P=.0001), and chronic kidney disease was associated with a significantly higher risk of AMI (HR, 2.41; 95% CI, 1.73-3.36), and CVA (HR, 1.80; 95% CI, 1.44-2.24). Compared with patients who received neither tenofovir nor abacavir, patients who received tenofovir had lower risk of AMI (HR, 0.16; 95% CI, .08-.33; P=.0001) and CVA (HR, 0.22; 95% CI, .15-.32; P=.001). Use of abacavir was associated with lower risk of CVA (HR, 0.60; 95% CI, .45-.79).
  
  
  CONCLUSIONS
  We observed no association between cumulative or current abacavir use and AMI or CVA. Abacavir use was more common than was tenofovir use among patients with prior chronic kidney disease, and chronic kidney disease independently predicted higher rates of AMI and CVA.
authors.affiliation: VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas 75216, USA. roger.bedimo@med.va.gov
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Bedimo
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Westfall
authors.forename: Henning
authors.initials: H
authors.lastname: Drechsler
authors.forename: Gabriela
authors.initials: G
authors.lastname: Vidiella
authors.forename: Pablo
authors.initials: P
authors.lastname: Tebas
mesh_terms: D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015224:Dideoxynucleosides / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000139:chemically induced / Q000453:epidemiology / Q000821:virology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000139:chemically induced / Q000453:epidemiology* / Q000821:virology; D063065:Organophosphonates / Q000009:adverse effects / Q000627:therapeutic use; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000139:chemically induced / Q000453:epidemiology / Q000821:virology; D012307:Risk Factors; D020521:Stroke / Q000139:chemically induced / Q000453:epidemiology* / Q000821:virology; D000068698:Tenofovir; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D000099227:Abacavir
chemical_list: D000225:Adenine; D019380:Anti-HIV Agents; D015224:Dideoxynucleosides; D063065:Organophosphonates; D000068698:Tenofovir; D000099227:Abacavir