Recent abacavir use and incident cardiovascular disease in contemporary-treated people with HIV

Nadine Jaschinski, Lauren Greenberg, Bastian Neesgaard, Jose M Miró, Katharina Grabmeier-Pfistershammer, Gilles Wandeler, Colette Smith, Stéphane De Wit, Ferdinand Wit, Annegret Pelchen-Matthews, Cristina Mussini, Antonella Castagna, Christian Pradier, Antonella Monforte, Jörg Vehreschild, Anders Sönnerborg, Alain Volny Anne, Andrew Carr, Loveleen Bansi-Matharu, Jens LundgrenHarmony Garges, Felipe Rogatto, Robert Zangerle, Huldrych F Günthard, Line D Rasmussen, Coca Nescoi, Marc Van Der Valk, Marianna Menozzi, Camilla Muccini, Amanda Mocroft, Lars Peters, Lene Ryom, RESPOND Study Group


OBJECTIVE: Assessing whether the previously reported association between abacavir (ABC) and cardiovascular disease (CVD) remained amongst contemporarily treated people with HIV.

DESIGN: Multinational cohort collaboration.

METHODS: RESPOND participants were followed from the latest of 1 January 2012 or cohort enrolment until the first of a CVD event (myocardial infarction, stroke, invasive cardiovascular procedure), last follow-up or 31 December 2019. Logistic regression examined the odds of starting ABC by 5-year CVD or chronic kidney disease (CKD) D:A:D risk score. We assessed associations between recent ABC use (use within the past 6 months) and risk of CVD with negative binomial regression models, adjusted for potential confounders.

RESULTS: Of 29 340 individuals, 34% recently used ABC. Compared with those at low estimated CVD and CKD risks, the odds of starting ABC were significantly higher among individuals at high CKD risk [odds ratio 1.12 (95% confidence interval = 1.04-1.21)] and significantly lower for individuals at moderate, high or very high CVD risk [0.80 (0.72-0.88), 0.75 (0.64-0.87), 0.71 (0.56-0.90), respectively]. During 6.2 years of median follow-up (interquartile range; 3.87-7.52), there were 748 CVD events (incidence rate 4.7 of 1000 persons-years of follow up (4.3-5.0)]. The adjusted CVD incidence rate ratio was higher for individuals with recent ABC use [1.40 (1.20-1.64)] compared with individuals without, consistent across sensitivity analyses. The association did not differ according to estimated CVD (interaction P  = 0.56) or CKD ( P  = 0.98) risk strata.

CONCLUSION: Within RESPOND's contemporarily treated population, a significant association between CVD incidence and recent ABC use was confirmed and not explained by preferential ABC use in individuals at increased CVD or CKD risk.

Original languageEnglish
Issue number3
Pages (from-to)467-475
Number of pages9
Publication statusPublished - 1 Mar 2023


  • Cardiovascular Diseases/chemically induced
  • Disease Progression
  • HIV Infections/complications
  • Humans
  • Renal Insufficiency, Chronic/complications
  • Risk Factors


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