Abacavir myocardial infarction

Sanz E. Abacavir—myocardial infarction, WHO Signal 2005 http //www.who-umc. org/graphics/15962.pdf. 

Abacavir NRTT1 300 mg bid Testing to rule out the presence of the HI A-B 5701 allele is recommended prior to the initiation of therapy Rash, hypersensitivity reaction, nausea. Possible increase in myocardial infarction Avoid alcohol... 

Based on these data it has been calculated that the NNTh for myocardial infarction due to abacavir changes with the underlying individual risk for example, in smokers with a systolic blood pressure of 160 mmHg and a 5-year risk of myocardial infarction of 1.3% the NNTh is 85, but it increases to 277 if the patient is a non-smoker and to 370 if the systolic blood pressure is below 120 mmHg [86 ]. 

The association between the use of abacavir and an increased risk of myocardial infarction has been confirmed in a prospective nationwide cohort study that included 2952 Danish HIV-infected patients taking highly active antiretroviral therapy (HAART) from 1995 to 2005 [87 =]. Hospitalization rates for myocardial infarction were 2.4 per 1000 person-years (95% Cl = 1.7, 3.4) for abacavir non-users and 5.7 per 1000 person-years (95% Cl = 4.1, 7.9) for abacavir users. The risk of myocardial infarction increased after abacavir was started (unadjusted IRR = 2.22 95% Cl = 1.31, 3.76 IRR adjusted for confounders = 2.00 95% Cl = 1.10, 3.64 IRR adjusted for propensity score = 2.00 95% Cl = 1.07, 3.76). This effect was also observed among patients who started to take abacavir within 2 years after the start of HAART and among patients who started to take abacavir as part of a triple nucleoside reverse transcriptase inhibitor (NRTI) regimen. 

In contrast to these findings, a retrospective investigation of the clinical trials database held by the manufacturer showed no association of abacavir with myocardial infarction [88 =, 89 ]. 

Post FA, Campbell LJ. Abacavir and increased risk of myocardial infarction. Lancet 2008 372(9641) 803. 

Kowalska JD, Kirk O, Mocroft A, Hoj L, Friis-M0ller N, Reiss P, Weller I, Lundgren JD. Implementing the number needed to harm in clinical practice risk of myocardial infarction in HIV-l-infected patients treated with abacavir. HIV Med 2010 11(3) 200-8. 

Obel N, Farkas DK, Kronborg G, Larsen CS, Pedersen G, Riis A, Pedersen C, Gerstoft J, S0rensen HT. Abacavir and risk of myocardial infarction in HTV-infected patients on highly active antiretroviral therapy a population-based... 

Brothers CH, Hernandez JE, Cutrell AG, Curtis L, Ait-Khaled M, Bowlin SJ, Hughes SH, Yeo JM, Lapierre DH. Risk of myocardial infarction and abacavir therapy no increased risk across 52 GlaxoSmithKline-sponsored clinical trials in adult subjects. J Acquir Immune Defic Syndr 2009 51(1) 20-8. 

Ding X, Andraca-Garrera E, Gooper G, Miele P, Kornegay C, Soukup M, et al. No association of abacavir use with myocardial infarction findings of an FDA meta-analysis. J Acquir Immrme Defic Syndr 2012 61(4) 441-7. 

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