YOU ARE HERE:
Abacavir remains an equal first for people starting HIV treatment in US
Michael Carter, Thursday, April 10, 2008
US HIV treatment guidelines are to continue to recommend abacavir for first-line antiretroviral therapy, according to a statement issued by the Department of Health and Human Services (DHHS) on April 4th.

Guidelines issued in January by the DHHS recommended either abacavir/3TC or tenofovir/FTC as nucleoside backbones for patients starting antiretroviral therapy.

But, soon after these guidelines were issued, preliminary data from the D:A:D study suggested that treatment with abacavir almost doubled the risk of heart attack, particularly in patients with existing cardiovascular risk factors.

Furthermore, the separate ACTG 5202 study showed that patients taking abacavir/3TC who started anti-HIV therapy with a viral load above 100,000 copies/ml were less likely to achieve an undetectable viral load after a year than patients with a viral load of this level who took tenofovir/FTC.

Drug regulatory authorities in both the US and Europe have said that it is too early to say if abacavir does increase the risk of heart attack, particularly as neither tenofovir nor FTC were assessed in the D:A:D data.

The makers of abacavir, GlaxoSmithKline, have looked at the results of their studies during abacavir’s development and found no evidence that the drug increased heart attack risk. Although regulators on both sides of the Atlantic said they would continue to monitor the situation, they are not, at this stage, proposing to amend abacavir’s licence.

However, draft UK HIV treatment guidelines, issued by the British HIV Association, now recommend tenofovir/FTC as the first-choice nucleoside backbone. Abacavir/3TC is an alternative, but the draft guidelines state it “should be…used with caution in those with viral loads over 100,000 copies/ml.” The UK guidelines also state that the D:A:D results linking abacavir to a risk of heart attack are “subject to further analysis”, nevertheless, “these results should caution the choice of [abacavir/3TC] in patients with a high risk of cardiovascular disease.”