Georg Behrens

In RESPOND, cardiovascular events were not related to HIV viremia. A large South African cohort did not find evidence for increased CVD risk in people who initiated DTG and another observational cohort in four African countries found no positive association of incident hypertension and use of DTG.

In RESPOND, neither current, pre-antiretroviral therapy, nor cumulative viremia had statistically significant associations with cardiovascular disease (CVD) when adjusted for other risk factors. Some researchers had suggest that DTG could lead to higher rates of CVD events since it supports weight gain. However, a report at this conference from a large South African cohort with medium term follow-up did not find evidence of increased risk of CVD in people who initiated TDF/3TC/DTG versus TDF/FTC/EFV. In contrast, abacavir did it again: REPRIVE confirmed previous reports and found that current and former use of abacavir was associated with a higher incidence of subsequent major adverse cardiovascular events (42%-50% higher risk) in adjusted models. This association was independent of INSTIs, NNRTIs or PIs as part of the regimen. What about DTG and hypertension? Again no new evidence supporting this. In a prospective observational cohort in four African countries no evidence was found to support that DTG use was positively associated with incident hypertension during a 3-4 year follow up.

Previous observational studies indicating an association between HIV viremia and CVD could not adjust for CVD risk factors, which makes the RESPOND data relevant. This cohort has rigorously validated endpoints and rich data on CVD risk factors, but half of the cohort was excluded from the analysis. The overall CVD event rate in the South African study was rather low (n=33) and patients were relatively young, which compromises the power of the investigation. Great to see a study on incident arterial hypertension, which was rather high (13.1%) and some indication that nevirapine could be contributing.