Cardiovascular Hazards of Abacavir- Versus Tenofovir-Containing Antiretroviral Therapies: Insights From an Analysis of the REPRIEVE Trial Cohort

作者：Emma Smith, Carlos Malvestutto, Heather J. Ribaudo, Carl J. Fichtenbaum, Judith A. Aberg, Maya Watanabe, Gerald S. Bloomfield, Judith S. Currier, Sarah M Chu, Kathleen V. Fitch, Marissa R Diggs, Roger Bedimo, Javier Valencia, Cristina Gómez‐Ayerbe, Indira Brar, José Valdez Madruga, Michael T. Lu, Pamela S. Douglas, Markella V. Zanni, Steven Grinspoon · 发表于：Open Forum Infectious Diseases · 年份：2025 · DOI：10.1093/ofid/ofaf177 · 被引用次数：11 · 研究领域：HIV-related health complications and treatments、HIV/AIDS drug development and treatment、Lipoproteins and Cardiovascular Health

Background: Prior analyses suggest that the nucleoside reverse transcriptase inhibitor (NRTI) abacavir (ABC), but not tenofovir (TFV), is associated with a 2-fold increase in the hazard of myocardial infarction. the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) is ideally suited to evaluate the role of ABC and the TFV backbones, tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF), in major adverse cardiovascular events (MACE). Methods: We compared hazard of first MACE among people living with human immunodeficiency virus (HIV) at low-to-moderate cardiovascular risk using ABC (n = 883), TAF (n = 957), and TDF (n = 4274) at entry. Overlap weights balanced biasing factors, including age, sex at birth, atherosclerotic cardiovascular disease risk, CD4 count, estimated glomerular filtration rate, and anchor antiretroviral therapy. Associations between entry NRTI and MACEs were estimated using a marginal Cox proportional hazards model. Change of NRTI, or "switching," was common during follow-up. Additional associations were estimated by further censoring at first switch and applying time-updated inverse probability of censoring weighting (IPCW). Results: Baseline-adjusted associations suggest clinically relevant increases in hazard of first MACE for ABC versus TAF (hazard ratio [HR], 1.5 [95% confidence interval {CI}, .9-2.3]) and ABC versus TDF (HR, 1.4 [95% CI, .9-2.1]), but not TAF versus TDF (HR, 0.9 [95% CI, .6-1.5]). With censoring at switch, HR...