Abacavir & Inflammation...

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Just to add to the already confused picture...

From AIDSMed July 1, 2010

HIV-Positive People on Abacavir Don't Have More Inflammation

HIV-positive women and men do not appear to have increased signs of

cardiovascular inflammation when they take abacavir (found in Ziagen, Epzicom

and Trizivir), according to a study published online June 25 in the journal

AIDS. These results stand in contrast to a couple of previous studies that found

not only higher levels of inflammatory proteins in abacavir takers, but also an

increased risk for heart attacks.

Members of the HIV community were surprised when the Data Collection on Adverse

Events of Anti-HIV Drugs (D:A:D) study reported in February 2008 that people

using abacavir had about a 90 percent increase in the likelihood of having a

heart attack. A subsequent analysis of data from the Strategies for Management

of Anti-Retroviral Therapy (SMART) study confirmed these findings.

The SMART and D:A:D studies also found that abacavir was associated not only

with an increased heart attack risk, but also with an increase in blood levels

of proteins that are often associated with cellular inflammation in the

circulatory system, and an increased risk of cardiovascular disease (CVD).

Contrary to D:A:D and SMART, however, several subsequent studies from large

cohorts found no consistent increase in either heart attack risk or inflammatory

protein levels in abacavir takers.

To explore this matter, Palella, MD, from Northwestern University Feinberg

School of Medicine in Chicago, and his colleagues analyzed data from two large

U.S. studies: the Women's HIV Interagency Cohort Study (WHIS) and the

Multicenter AIDS Cohort study (MACS). In all, Palella's team looked at blood

levels of inflammatory proteins in 1,508 women and men before and after they

started taking potent combination ARV therapy. Though none of these people were

on combination therapy at the first study visit included in the analysis, some

were taking one or two ARV drugs before beginning combination therapy.

Half the group started a regimen that included abacavir, and half did not

include abacavir in their regimen. The two groups were matched based on a number

of factors so as to ensure that they were as similar as possible. The study

looked for changes in three inflammatory proteins—interleukin-6 (IL-6), high

sensitivity C-reactive protein (hsCRP) and D-dimer—but not heart attacks.

Palella and his colleagues found abacavir was not associated with differences in

inflammatory protein levels. This was true whether people were initiating ARV

therapy for the first time, or had taken it at some point in the past.

The authors caution that, " This work should not be interpreted as either

refuting or supporting hypotheses suggesting associations between recent use of

abacavir (or any other [ARV drug] for that matter) and CVD in general or

specific CVD endpoints.

" However, our work does suggest that, if recent [abacavir] use is indeed

associated with increase risk for adverse cardiovascular events, system

inflammation is not likely the sole or primary means by which its effects are

mediated, " they conclude.