Call to drop abacavir from use in adults
13 July 2025. Related: Journal scan, Antiretrovirals, Treatment strategies, Coinfections and complications.
Simon Collins, HIV i-Base
An editorial comment in Lancet HIV by prominent UK HIV consultants, Laura Waters and Nicola Mackie, calls for doctors to actively look at whether abacavir still has a role in adult HIV care. [1]
The article suggests that it might be more important to proactively switch away from further use in most adults.
This move is prompted by additional recent results from the international REPRIEVE study, which showed 41% higher risk of major cardiovascular events in participants with current use of abacavir or and 61% increase in those with previous use. Median time on abacavir was about 10 years. The article also noted that REPRIEVE only enrolled participants whose CVD risk was lower than the recommended threshold at the time to use statins. [2]
The article also reviews current recommendations in different guidelines.
It importantly notes that options are more limited for paediatric care and also that increased cardiovascular risks haven’t been reported with abacavir use in this population. This would be highly unlikely given the short-term follow-up in paediatric studies. Additionally, there is no rationale for why the mechanism responsible for increased risks would be any different in children compared to adults.
For those with a long memory, perhaps abacavir is the new stavudine. [3]
References
- Waters L and Mackie N. Time to say farewell to abacavir? The Lancet HIV, Volume 12, Issue 7, e467 – e468.
https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(25)00123-7 - Fichtenbaum CJ et al. Effects of antiretrovirals on major adverse cardiovascular events in the REPRIEVE trial: a longitudinal cohort analysis, Lancet HIV. Published online 4 June 2025.
https://doi.org/10.1016/S2352-3018(25)00043-8 - Andrieux-Meyer I et al. “Why it’s time to say goodbye to stavudine…everywhere.” Southern African Journal of HIV medicine. 2012-03-01.
https://sajhivmed.org.za/index.php/hivmed/article/view/155
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