Do Abacavir and ddI (Didanosine) Contribute to Risk of Heart Attack?

This was the topic of a presentation at the 15th Conference on Retroviruses and Opportunistic Infections (CROI) in Boston in February 2008. Researchers from a large European database that collects information on over 200 HIV clinics unexpectedly found that recent use of abacavir (in the past six months), and to a lesser extent ddI, was linked to an increased risk of heart attacks.

Although the overall level of heart attack was low (1.6%) in the group of more than 33,000 HIV+ individuals studied, it was nonetheless double the rate that would otherwise be expected.

These findings, which continue to be investigated, are focusing for now on the particular risk that taking abacavir (or ddI) might present for those who already have some risk factor for cardiovascular disease, such as being diabetic, being a smoker, having high blood pressure, or having higher than normal lipids (cholesterol and triglycerides). Also under discussion is whether screening for hypersensitivity to abacavir (shown by about 8% of people), which is a simple blood test, could steer those most susceptible to this increased heart attack risk away from abacavir.

It’s also clear that many HIV positive people taking abacavir could take steps to minimize their risk for cardiovascular disease by:

1. quitting smoking
2. lowering high lipid levels
3. lowering high blood pressure
4. getting treatment for diabetes
5. changing diet
6. starting an exercise program

(See entries on this blog for some suggestions regarding #s 2, 3, and 4.)

We’ve presented the above information based especially on the Canadian AIDS Treatment Information Exchange treatment update on this topic, which includes a bibliography for further reading. The complete CATIE update can be read at:

http://www.catie.ca/catienews.nsf/00a48c8905294f0b8525717f00661eb8/5a61325343866b8b8525741d005d20ce!OpenDocument

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