Comparative Safety and Changes in Immunologic and Virologic Parameters of Dolutegravir versus Efavirenz-Based Antiretroviral Therapies Among HIV Patients: A Retrospective Cohort Study.

IF 1.5 Q4 INFECTIOUS DISEASES HIV AIDS-Research and Palliative Care Pub Date : 2023-01-01 DOI:10.2147/HIV.S396420
Melese Alemnew Ayal, Alemseged Beyene Berha
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Abstract

Background: In combination with other two antiretroviral drugs, an efavirenz (EFV) or dolutegravir (DTG)-based regimen is the treatment of choice for human immunodeficiency virus (HIV) infection. This study aimed to determine the safety and changes in immunologic and virologic parameters of DTG compared with EFV-based ART as first-line HIV treatment among HIV patients.

Methods: A retrospective hospital-based cohort study was carried out from September 1, 2019 to August 30, 2020 at HIV clinics of three selected hospitals in North-West-East Ethiopia, Amhara Region. All HIV patients ≥3 years old, who had been on either DTG or EFV-based combination anti-retroviral therapy (cART), and had detectable viral load (VL) were included. Descriptive and multivariate Cox regression analyses were used.

Results: Overall, 990 HIV patients were included in the analysis (DTG n=694, EFV n=296). A VL of <50 copies/mL was observed in 69% of patients in the DTG group and 66% in the EFV group (crude hazard ratio [CHR] =1.28, 95% CI: 1.08-1.51; p=0.004). Out of the total, 289 (42%) of the patients in the DTG group reported adverse drug events (ADEs) compared with 147 (50%) in the EFV group (p=0.020). Younger age, opportunistic infections (OIs), bed-ridden condition, no prophylaxis for OIs, low baseline cluster of differentiation 4 (CD4) count, high baseline VL, poor adherence, and ADEs were predictors of poor survival, and younger age, OIs, low baseline CD4, DTG-based initial regimen, poor adherence with cART, naïve treatment history, and student job type were predictors of poor safety outcomes.

Conclusion: The DTG-based regimen demonstrates an improved viral suppression and CD4 cell recovery, and better safety profile compared with the EFV-based regimen for the treatment of HIV-infected patients. A baseline CD4+ T-cell count <200 cells/mm3, OIs, and poor adherence with therapy were factors associated with poor survival and safety outcomes. HIV patients with these risk factors should be treated and monitored regularly.

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在HIV患者中,多来替韦与以依非韦伦为基础的抗逆转录病毒治疗的安全性及免疫和病毒学参数的变化:一项回顾性队列研究。
背景:与其他两种抗逆转录病毒药物联合,以依非韦伦(EFV)或多替格拉韦(DTG)为基础的方案是治疗人类免疫缺陷病毒(HIV)感染的首选。本研究旨在确定DTG与基于efv的ART作为一线HIV治疗在HIV患者中的安全性及免疫学和病毒学参数的变化。方法:于2019年9月1日至2020年8月30日在埃塞俄比亚西北-东部阿姆哈拉地区三家医院的HIV诊所进行回顾性医院队列研究。所有年龄≥3岁、接受过DTG或以efv为基础的联合抗逆转录病毒治疗(cART)并具有可检测病毒载量(VL)的HIV患者均被纳入研究。采用描述性和多变量Cox回归分析。结果:共纳入990例HIV患者(DTG n=694, EFV n=296)。VL =0.004)。其中,DTG组289例(42%)患者报告了药物不良事件(ADEs),而EFV组147例(50%)患者报告了药物不良事件(ADEs) (p=0.020)。年龄较小、机会性感染(OIs)、卧床、未预防OIs、基线CD4计数低、基线VL高、依从性差和ADEs是不良生存的预测因素,年龄较小、OIs、基线CD4低、基于dtg的初始方案、对cART的依从性差、naïve治疗史和学生工作类型是不良安全性结果的预测因素。结论:与以efv为基础的方案相比,以dtg为基础的方案在治疗hiv感染患者方面表现出更好的病毒抑制和CD4细胞恢复,并且具有更好的安全性。基线CD4+ t细胞计数3、OIs和治疗依从性差是与生存和安全性差相关的因素。具有这些危险因素的艾滋病毒患者应定期接受治疗和监测。
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来源期刊
CiteScore
3.00
自引率
6.70%
发文量
61
审稿时长
16 weeks
期刊介绍: About Dove Medical Press Dove Medical Press Ltd is part of Taylor & Francis Group, the Academic Publishing Division of Informa PLC. We specialize in the publication of Open Access peer-reviewed journals across the broad spectrum of science, technology and especially medicine. Dove Medical Press was founded in 2003 with the objective of combining the highest editorial standards with the ''best of breed'' new publishing technologies. We have offices in Manchester and London in the United Kingdom, representatives in Princeton, New Jersey in the United States, and our editorial offices are in Auckland, New Zealand. Dr Scott Fraser is our Medical Director based in the UK. He has been in full time clinical practice for over 20 years as well as having an active research interest.
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