Global "expiration" of abacavir in adults with HIV: a rapid review of safety and efficacy concerns challenging its role in modern ART

Emerging evidence from the REPRIEVE study cohort has further clarified the association between abacavir use and cardiovascular risk. This analysis, along with previous findings, demonstrates a significant elevation in time to first major adverse cardiovascular events (MACE) among adults living with HIV with current or past abacavir exposure. Given the availability of safer, equally effective alternative ART regimens with fewer cardiovascular risks, the continued clinical relevance of abacavir in adults living with HIV should be critically reassessed. Considering these findings, abacavir should be considered an obsolete option for most, if not all, adults living with HIV. This perspective shift emphasizes the importance of selecting ART regimens that optimize long-term cardiovascular health while achieving durable virologic suppression in the modern era of HIV treatment.