April 2025 TTU: Updated Guidelines: Abacavir Removed From Recommended ART Regimens

Topics, Trends & Updates

April 2025

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Updated Guidelines: Abacavir Use and Cardiovascular Risk

Recent studies have strengthened the association between abacavir (ABC) use and increased cardiovascular disease (CVD) risk in people with HIV. The Medical Care Criteria Committee worked with the lead authors to update recommendations, tables, and text on ABC use in 4 guidelines:

Rapid ART Initiation

Lead Author: Asa E. Radix, MD, MPH, PhD, FACP, AAHIVS

Update: In the General Principles in Choosing a Regimen for Rapid ART Initiation section: Text added on avoiding ABC in an initial ART regimen because of the association between ABC use and increased cardiovascular risk.

Contents:

Selecting an Initial ART Regimen

Lead Author: Antonio E. Urbina, MD

Updates:

In the Available Antiretroviral Medications section:
Table 1: ABC/3TC/DTG removed and listed in Table 3 as an other regimen (not preferred or alternative); TAF 25 mg/FTC or TDF 300 mg/FTC and RAL HD removed and listed as an alternative regimen.
Tables 2 and 3: Regimens containing ABC/3TC (Epzicom) removed.
In the Special Considerations for Comorbid Conditions section: Text added on the association between ABC use and increased cardiovascular risk and avoiding ABC in an initial regimen.

Contents:

Second-Line ART After Treatment Failure or For Regimen Simplification

Lead Author: Joseph P. McGowan, MD, FACP, FIDSA, AAHIVS

Updates:

Global: Text and citations added throughout, including discussion of data from the CARES, 2D, REPRIEVE, DEFINE, SOLAR-3D, and PASO-DOBLE studies
ART Changes to Address Drug Resistance section: Enfuvirtide (T20) removed from Box 1 and subsequent discussion, as this drug is being discontinued in the United States
ART Changes for Adverse Effects, Drug-Drug Interactions, or Pregnancy section: Text added on the association between abacavir (ABC) use and increased cardiovascular risk and on avoiding ABC or using it with caution in people with HIV

Contents:

Primary Care for Adults With HIV

Lead Authors: Christine Kerr, MD; Mary Dyer, MD

Updates: In the HIV-Specific Primary Care section, text added on the association between abacavir (ABC) use and increased cardiovascular risk and on avoiding ABC or using it with caution in people with HIV.

Contents:

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