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Author Topic: heart attack / abacavir  (Read 758 times)

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Offline shawnodese

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  • Posts: 3
heart attack / abacavir
« on: June 16, 2015, 06:21:40 PM »
What is the latest on abacavir links to heart attacks?
« Last Edit: June 16, 2015, 06:25:40 PM by shawnodese »

Offline tednlou2

  • Member
  • Posts: 5,388
Re: heart attack / abacavir
« Reply #1 on: June 17, 2015, 12:29:48 AM »
Here's what Dr. Gallant said recently about the anticipated study results, which he thought may settle the issue.  This is something I wonder about-- Why does it seem to possibly have risks for those with existing cardiac risks, but not those who don't?  If it is causing cardiac issues, is it still doing some damage to those with no existing risks?

"You’re right–I promised to talk about the new study but I never did. It may have slipped my mind because the results weren’t as definitive as we had hoped they would be, and they’re very complicated to discuss.  The short version is that the study did show an association between abacavir and heart attack, which was statistically significant in some of the analyses they performed, but not in others. The authors still have more work to do, with additional complex statistical models, and I can see it going either way.

In the meantime, there is still reason to be cautious and to avoid abacavir if you have multiple cardiac risk factors. Fortunately, you don’t."

http://hivforum.tumblr.com/search/Abacavir+

Offline Almost2late

  • Member
  • Posts: 650
  • Life goes on
Re: heart attack / abacavir
« Reply #2 on: June 17, 2015, 01:29:16 AM »
I'm on this med in Triumeq for 3 months now, I'm 54, I exercise regularly, with good blood pressure and haven't noticed any problems with my heart yet.. I'm not sure if I would be considered a risk since I smoked for 38 years but quit a year and a half ago.. From my understanding abacavir has been around for a while, so I would assume if it was a significant risk then we would have heard much more by now.

Offline shawnodese

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  • Posts: 3
Re: heart attack / abacavir
« Reply #3 on: June 17, 2015, 03:37:16 PM »
Should a patient that's been on abacavir for 8-10 years and just had a heart attack with a stent placed get off of their Viread+Epivir+Issentress+abacavir regimen and switch to something like Tivicay+Truvada if that's an option? or should they just stay on their current regimen if that's keeping them undetectable?  Note: Patient also takes Lisinopril, Metopralol, Aspirin, Plavix, and Lipitor.  If they stay on the abacavir regimen another question would be how much do the heart medications protect against another event - whether it was caused by abacavir or not?
« Last Edit: June 17, 2015, 04:02:33 PM by shawnodese »

Offline JimDublin

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  • Posts: 149
Re: heart attack / abacavir
« Reply #4 on: June 17, 2015, 04:59:46 PM »
Should a patient that's been on abacavir for 8-10 years and just had a heart attack with a stent placed get off of their Viread+Epivir+Issentress+abacavir regimen and switch to something like Tivicay+Truvada if that's an option? or should they just stay on their current regimen if that's keeping them undetectable?  Note: Patient also takes Lisinopril, Metopralol, Aspirin, Plavix, and Lipitor.  If they stay on the abacavir regimen another question would be how much do the heart medications protect against another event - whether it was caused by abacavir or not?

That's a bit more than just theory or curiosity into a link for study or up to date info on abacavir and heart problems. Most of the meds mentioned are beta blockers and hypertension/blood clot treatments if I am not mistaken.

Are you the patient you're speaking of and are you HIV+ ? and have you spoken to your HIV doc / consultant regarding the switch and interactions ?
« Last Edit: June 17, 2015, 05:06:24 PM by JimDublin »
To quote my sister:
See my theory is dad farted so much near us as kids that he has given me all these deficiencies! So be careful where you fart! 😁

Offline eric48

  • Member
  • Posts: 1,264
Re: heart attack / abacavir
« Reply #5 on: June 17, 2015, 05:18:49 PM »
Who ever the patient is, you or a friend of yours, my comment is that the patient is taking a lot of medication

We are all at risk of this polypharmacy, where interactions are not fully understood

The ArV regimen is build around 4 molecules. Using the potency of the most modern integrase inhibitors, it would be worthwhile to open a discussion with doc towards simplification. The 2 latest, most recent integrase inhibitors are foud in Stribuild (EVG) and Tivicay (DTG). When there is polypharmacy, it may be reasonnable to avoid medication that include a booster, as a booster may lower or increase the levels of the other medication

In that respect, your suggestion of using Tivicay seems reasonnable

Further on, maintenance regimen using Tivicay and Rilpivirine , are in phase III trials, so if eligible your suggestion would decrease the number of ARV from 4 to 3 . And , if the trials go as expected, this route may lead to a further reduction down to 2

You may also want to know that the is an on going clinical trial that will test Tivicay, used alone, as maintenance therapy.

This to highligth the prospects of possible future improvment, that may help reduce the polypharmacy
NVP/ABC/3TC/... UD (non-infectious) ; CD4 > 1000; CD4/CD8 ~ 2.0   stock & donations : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: use of NVP & 3TC generics
https://clinicaltrials.gov/ct2/show/NCT02157311

Offline J.R.E.

  • Member
  • Posts: 7,389
  • Joined Dec-2003 Living positive, since 1985.
Re: heart attack / abacavir
« Reply #6 on: June 17, 2015, 05:39:40 PM »
hey,...

I have been on abacavir, since December of 2003. Since that time, I have been placed on Hydrochlorothiazide 25mg once a day, also I was placed on Simvastatin 40mg taken once a day,  I also take Metoprolol Tartrate 25 MG taken twice a day.

The thought of Abacavir and the risk of a heart attack still concerns me, but there are other issues that concern me more.

There is no family medical history of heart disease in my family. No family menber has ever had a heart attack.  My father died from an aneurism in the brain. Cancer is another story though. And that is more of a concern to me than Abacavir .

I was a smoker at one time but quit, over 25 years ago. My diet is pretty good, but I should exercise a bit more.  My current weight is 179 lbs @ 5 feet 7 inches.

The last BMI index done was was 27.0, which was done last October. This will be rechecked this coming November, by my Primary care.

My blood pressure is currently fine and controlled through the above mentioned medications, and my cholesterol is also controlled through the above mentioned medication.

I want to mention also, that I will be 64 years of age this year and EDITED 30 years positive. ( Not 33 years)

I have never had a heart attack or stroke.

I could exercise more, and could stand to loose 10- 15 pounds, but overall, I think I am in better health than some of my HIV negative friends, at the same age. I don't like making comments like that.... Tomorrow I might have a heart attack, and that would certainly suck big time.   ::)

I have an appointment with my ID doctor,  next Tuesday,  And once again, I will bring up all these points and get his opinion on Abacavir and the risk of a heart attack, as I have done in the past.

But honestly for now, as I mentioned earlier I am concerned but not worried at this point in my life. Cancer is more of a concern for m, with my family history.


Ray  8)
« Last Edit: June 17, 2015, 05:50:07 PM by J.R.E. »
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 25 mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


Diagnosed positive in 1985,.. In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started on  HAART on October 24th, 2003.

 As of 4/1/15,  t-cells are at 437,   Viral load remains <40

Current % is at 15%

  
 63 years young.

Offline shawnodese

  • Member
  • Posts: 3
Re: heart attack / abacavir
« Reply #7 on: June 17, 2015, 06:58:02 PM »
To summarize so far:

tednlou2: " results weren’t as definitive as we had hoped they would be" and "there is still reason to be cautious and to avoid abacavir if you have multiple cardiac risk factors"

almost2late: "if it was a significant risk then we would have heard much more by now."

J.R.E healthy since 2003 and controlling most risk with heart medication

Almost2Late also controlling most risk through healthy lifestyle

So it looks like maybe abacavir might be okay as long as you control cardiovascular risks through traditional means.

eric48's comments about polypharmacy are especially important to consider though especially when something as simple as certain foods, allergy or heartburn medicine can land you in the ER.  Value in simplifying regimens whenever possible.

I guess there's no paper or study yet that really condemns the abacavir or it's more complicated and only problematic when the risks are controlled through traditional means?
« Last Edit: June 17, 2015, 07:00:07 PM by shawnodese »


Offline eric48

  • Member
  • Posts: 1,264
Re: heart attack / abacavir
« Reply #9 on: June 17, 2015, 08:33:54 PM »
I guess there's no paper or study yet that really condemns the abacavir or it's more complicated and only problematic when the risks are controlled through traditional means?

In fact , there are reports that do show an association, and reports that dońt.

As an ABC user , I ´ve looked into it care fully...

What scares patient, in an unfair fashion, is the use of relative risks vs absolute risk.

In 1000 patients you will see 2 nasty events with one drug, and in another 1000 you will see 3

3 vs 2.  : the odds ratio is up 50 % !!! Isńt that scary ? Yes it is...
But you are still talking about rare events in both cases

So you should read the comments of the comments of the commentator, you should read the complete report and look for the absolute numbers...

You also need to use common sense:
Keep in mind that a number of patients enter treatment with , say, bad health condition to get started
Some of them have used injectable drugs, some are recovering from opportunistic infections. So they reach into care with some level of damage, especially in the renal function. Renal impairment is a strong predictor for cardiovascular problem.

This far from uncommon.

Because of renal impairment, doc will be carefull not to aggravate this risk... So this patient will be assigned to ABC, rather than TDF, for TDF may make things worse.

Say, this patient has a CVD... Is this due to the use of ABC, or the pre existing condition, that motivated the doctoŕs choice in the first place. So you find an association ... If you conclude that ABC is THE cause, then you make a mistake labelled channelling effect. So you need to look into the database that you use for your statistics...
It could have millions of patients, but , in your table, if you have not recorded baseline renal functions, then your database is worthless...

That kind of common sense is obfuscated by the epidemiologists, who has had no say in how the the database was structured in the first place

An other opportunity to use common sense:

A recent study did show a relative increase in odd ratio with the use of ABC
It also found a relative increase of odds ratio with the use of 3TC ( lamivudine aka Epivir)
The relative increase was the same...(fortunatly...)

why? Because the very vast majority of ABC users take it with 3TC, because this is the way it is coformulated
I have never come across a user taking ABC with FTC, nor one using TDF with 3TC. Simply because of exclusive industrial aggrements

So you understand why the relative risk was seen in BOTH ABC and 3TC, and that is was the exact same number...

yet, the staticians who analyzed the huge, really huge , robust database, concluded that...the use of 3TC carried a risk of CVD !

so people crush numbers, not really aware that some variables are not independant... And report relative risk (instead of absolute risks) to impress even more the unaware reader and their sloppy bosses

So sometimes, one has to really come down to earth, and realize that there are huge commercial interests in spreading fear among patients and prescribers

I think the question was interesting, but since therevare and will be more and more alternative , and more and and more use of NRTI sparing regimen, especially for maintenance, the question will become pointless
NVP/ABC/3TC/... UD (non-infectious) ; CD4 > 1000; CD4/CD8 ~ 2.0   stock & donations : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: use of NVP & 3TC generics
https://clinicaltrials.gov/ct2/show/NCT02157311

Offline eric48

  • Member
  • Posts: 1,264
Re: heart attack / abacavir
« Reply #10 on: June 18, 2015, 06:00:21 AM »
Finally found the paper I was referring to:

http://www.ncbi.nlm.nih.gov/pubmed/25908684

This is about all cardio events (alltypes , CVD, MI, ...), all serious events
Look at the absolute number and huge time span: the number of events is very very low...

This is the VA cohort ... Serious folks... They had looked into their database previously and reported nothing on ABC. By counting all types of serious cardio events, then they start seeing stuff... Including stuff you may never ever had heard about, before. Efavirenz as a cause... Lamivudine as the common culprit... And the most offensive combo was Sustiva+Combivir... Which is now very rarely used...

The good news is that we have a recent report (not yet published) in our local cohorts that do show that cardio events was a reality among treated patients. But, with better medication and better management with so called maintenance regimen, the trend is going down to a point where properly treated patients now have a cardio risk equal to that of age matched HIV negatives.

The same cohort also show that 1 in 5 patients has opted for maintenance therapy (monothereapy, mostly, dual therapy, to a certain extend, or FOTO for some)

So while (modestly) offending molecules are still used for the initial phase of treatment (be it ABC or TDF...), a growing number of patients, upon their doctors advise, switch to maintenance therapies.

Maintenance therapies typically do not use NRTIs.

Within our aging population,at riskof polypharmacy, HIV treatment simplification (maintenance therapies with only one or 2 molecules) is poised to be more and more common 
NVP/ABC/3TC/... UD (non-infectious) ; CD4 > 1000; CD4/CD8 ~ 2.0   stock & donations : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: use of NVP & 3TC generics
https://clinicaltrials.gov/ct2/show/NCT02157311

Offline Jeff G

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  • Member
  • Posts: 14,958
  • How am I doing Beren ?
Re: heart attack / abacavir
« Reply #11 on: June 18, 2015, 08:17:47 AM »
Eric ... You have been asked many times to stop using abbreviations for med names. Your post are confusing enough for many seasoned people living with HIV and all the more so for new members with little experience.

Offline Grasshopper

  • Member
  • Posts: 487
Re: heart attack / abacavir
« Reply #12 on: June 21, 2015, 04:13:48 AM »
Eric ... You have been asked many times to stop using abbreviations for med names.

For those of you that have issues recognizing the abbreviations :

http://www.aidsmeds.com/list.shtml

 ;)

Offline rcwebr

  • Member
  • Posts: 3
  • poz 30 years.
Re: heart attack / abacavir
« Reply #13 on: June 25, 2015, 05:18:07 PM »
After being on Atripla for 10 years now, my Dr. said that even though my numbers are great,  the atripla was probably causing my cholesterol levels and sugar levels to go up.  he wanted to put me on Abacavir.  However after doing a gene test, We found out that I  cannot take Abacavir.   so I just started Complera.  so far so good as of 3 weeks out.  Will see.  but Dr said I could have cardiovascular problems if i went on the Abacavir with  this particular gene.
poz 30 years.  full blown as of March 1986 with 72 T-Cells was given 6 months to live in 94 due to 0 T-cells for 4 years..  I'm still here.  now in good health.

 


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