Association Between Abacavir Exposure and Increased Risk for Cardiovascular Disease in Patients with Human Immunodeficiency Virus

Human immunodeficiency virus (HIV) infection and the receipt of antiretroviral therapy have been associated with the development of cardiovascular disease. The occurrence of cardiovascular events in HIV-infected patients has often been associated with treatment-induced dyslipidemia, insulin resistance, and body composition changes. These treatment-related complications are often the result of exposures to protease inhibitors or thymidine analogs such as stavudine or zidovudine. Recent investigations, however, have suggested an association between exposure to the nucleoside reverse transcriptase inhibitor, abacavir, and the occurrence of cardiovascular disease events. Based on these findings, current guidelines recommend using caution in patients receiving abacavir who are at a high risk for cardiovascular disease. Decisions to replace abacavir in a patient's regimen should be considered on an individual basis and with complete evaluation of the associated benefits and risks. Furthermore, additional studies are necessary to definitively determine the association between abacavir exposure and the occurrence of cardiovascular disease events. Studies are also necessary to definitively identify the contributions of both HIV infection and individual antiretroviral agents on the development of cardiovascular disease.