The REPRIEVE trial reveals a concerning link between abacavir, an HIV treatment, and increased cardiovascular risks, urging a reevaluation of its use in managing HIV.
At a Glance
- Abacavir increases the risk of major adverse cardiovascular events (MACE) in HIV patients.
- The REPRIEVE trial studied 7,769 patients to assess this risk.
- Statin therapies were considered for those at low-to-moderate cardiovascular risk.
- The study’s findings emphasize careful ART regimen selection.
Abacavir vs. Tenofovir: Cardiovascular Risk
Patients using abacavir-based antiretroviral therapy (ART) show a higher likelihood of experiencing MACE compared to those on tenofovir-based treatments. This risk elevation concerns both current and historical users of abacavir, highlighting the potential cardiovascular implications.
The REPRIEVE trial, a comprehensive study involving 7,769 participants across 12 countries, provides crucial insights. It primarily assessed the impact of statin therapy on patients with low-to-moderate cardiovascular risk, emphasizing integrating cardiovascular evaluations into treatment protocols.
Study Findings and Implications
MACE incidents were notably higher in patients on abacavir, occurring in 5% compared to 2% on tenofovir disoproxil fumarate (TDF) regimens. This pattern mirrored increased myocardial infarction rates in the abacavir cohort. Given these findings, the risk associated with abacavir necessitates careful deliberation when prescribing antiretroviral therapies.
“With the availability of potent and well-tolerated two and three drug ART regimens for both ART-naïve and experienced patients, it is no longer necessary to include ABC in the ART armamentarium.” – researchers – infectiousdiseaseadvisor
Secondary outcomes like hard MACE, which includes cardiovascular death, need to be weighed alongside therapeutic benefits when considering abacavir use. The study advocates for personalized treatment approaches, taking individual cardiovascular risk factors into account for safer patient outcomes.
A randomised trial to compare dolutegravir plus boosted darunavir versus recommended standard of care antiretroviral regimens in people with HIV-1, whose first-line non-nucleoside reverse transcriptase inhibitor therapy has failed
✅ Just Accepted
🔗 https://t.co/yALDEUQhia pic.twitter.com/EUvKLQG0eq— Clinical Infectious Diseases (@CIDJournal) July 4, 2025
Conclusion and Future Directions
The REPRIEVE trial underscores the necessity for revisiting abacavir’s role in HIV treatment due to its heightened cardiovascular risk. Health professionals are encouraged to engage in reflective prescribing practices, considering whether abacavir is the most ethical choice for high-risk cardiovascular patients.
“Next time, before prescribing abacavir-containing ART, we encourage prescribers to pause, reflect, and discuss with the person in front of them, who is already at greater risk of CVD [cardiovascular disease] than their HIV-negative counterparts, whether this really is the optimal, and ethical, choice” – authors in a commentary – medscape.com
As ART evolves, the study calls for potentially excluding abacavir from future regimens, advocating for risk-balanced, comprehensive strategies in managing HIV effectively.
