This review focuses on current studies addressing the association of abacavir (ABC) therapy and myocardial risk in HIV-infected patients, discusses potential pathogenetic mechanisms, and suggests a preliminary algorithm for decision making regarding ABC therapy in daily clinical practise.
The D:A:D study was the first to reveal an increased rate of myocardial infarction in patients recently treated with ABC. Subsequent analyses of both cohort studies as well as prospective randomized clinical trials largely confirmed this association. Although these studies varied considerably by design and their ability to control for confounders, they provide early support that ABC therapy can increase the risk for cardiovascular disease. The pathogenesis of this association remains elusive. Preliminary cross-sectional studies suggest the involvement of inflammation associated with ABC.
Prospective studies are required to provide additional evidence for the association of ABC therapy and cardiovascular events. In individual patients with underlying high cardiovascular risk, replacement of ABC may be considered, if it can be substituted by alternative equally effective treatment.
aClinic for Immunology and Rheumatology, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
bDepartment of Medicine, Division of Infectious Diseases, Tropical Medicine and Aids, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
Correspondence to Georg M.N. Behrens, MD, Clinic for Immunology and Rheumatology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany Tel: +49 0 511 532 5713; fax: +49 0 511 532 5324; e-mail: firstname.lastname@example.org