HIV Viral Rebound on Dolutegravir, Lopinavir, and Efavirenz: National Program Data Analysis From Ukraine.

Abstract

Background: Dolutegravir (DTG), an integrase strand transfer inhibitor, is recommended as the preferred first-line HIV medication globally because of higher efficacy, better tolerability, and higher genetic barrier to resistance compared with other antiretroviral therapy (ART) drug classes. However, little is known about the comparative effectiveness of DTG in sustaining durable viral suppression (VS) in real-world settings.

Methods: We analyzed data from electronic health records of a retrospective cohort of ART-naïve (N = 3793) and ART-experienced (N = 14,367) people receiving HIV treatment in Ukraine between October 2017 and September 2018, comparing incidence of viral rebound (viral load ≥ 200 HIV RNA copies/mL) after the first documented VS among participants on DTG-, ritonavir-boosted lopinavir-, and efavirenz-based regimens. Participants were followed until June 2019. Interval censoring survival analysis with cluster-robust standard errors was used to estimate the effects of ART regimen on viral rebound adjusting for demographic and clinical characteristics.

Results: N = 714 (3.9%) participants experienced viral rebound during follow-up. In the ART-naïve cohort, the incidence of rebound was 6.9 events [95% confidence interval (CI): 5.9 to 8.0] per 100 person-years. Ritonavir-boosted lopinavir-based regimens were associated with higher hazard of rebound compared with DTG-based regimens: adjusted hazard ratio = 1.8 (95% CI: 1.3 to 2.4). Efavirenz-based regimens had similar incidence of rebound compared with DTG: adjusted hazard ratio = 1.1 (95% CI: 0.9 to 1.3).

Conclusions: Favorable performance of DTG compared with other first-line ART options in sustaining VS supports continued roll-out of DTG-based regimens. High overall incidence of viral rebound, including on DTG-based regimens, calls for targeted evidence-based adherence support interventions and improved viral load and drug resistance monitoring, especially among high-risk populations.