Cardiovascular Disease Risk in Low- and Middle-Income Countries: Better Data for Better Evidence

Résumé fourni par la source

To the Editor—We thank Dr Martinez for their letter concerning our article, “Risk of major adverse cardiovascular events with dolutegravir versus efavirenz-based antiretroviral therapy: emulated target trials using routine, de-identified data from South Africa”, and for their careful considerations regarding the interpretation of our results [1, 2]. While our findings provide reassurance that in the short to medium term there is no large increased risk of major adverse cardiovascular events with dolutegravir, we agree that further data over longer follow-up times and among older people with human immunodeficiency virus (HIV) are required. These data are currently not available in low- and middle-income countries, where the majority of people taking dolutegravir live [3], because dolutegravir has only been widely available for the past 6 years, and the average age of people with HIV is generally younger than in high-income settings [4]. Over time, we plan to conduct these future analyses to determine cardiovascular risk over longer periods of dolutegravir exposure, and among older people, but comparing risk with other regimens will depend on whether there are subgroups of people with HIV who remain on non-dolutegravir regimens.

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