Suppression of HIV in the first 12 months of antiretroviral therapy: a comparative analysis of dolutegravir- and efavirenz-based regimens
ABSTRACT Objective To compare viral suppression in treatment-naïve adults starting antiretroviral therapy with dolutegravir (50mg)- and efavirenz (600mg)-based regimens. Methods We analyzed secondary data from Brazilian health information systems of people living with human immunodeficiency viru...
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| Format: | Article |
| Language: | English |
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Instituto Israelita de Ensino e Pesquisa Albert Einstein
2023-05-01
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| Series: | Einstein (São Paulo) |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1679-45082023000100213&lng=en&tlng=en |
| _version_ | 1797816783780970496 |
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| author | Gabriella Jomara da Silva Cássia Cristina Pinto Mendicino Cristiane Aparecida Menezes de Pádua Unaí Tupinambás |
| author_facet | Gabriella Jomara da Silva Cássia Cristina Pinto Mendicino Cristiane Aparecida Menezes de Pádua Unaí Tupinambás |
| author_sort | Gabriella Jomara da Silva |
| collection | DOAJ |
| description | ABSTRACT Objective To compare viral suppression in treatment-naïve adults starting antiretroviral therapy with dolutegravir (50mg)- and efavirenz (600mg)-based regimens. Methods We analyzed secondary data from Brazilian health information systems of people living with human immunodeficiency virus who started antiretroviral therapy between 2015 and 2017 in Minas Gerais, Brazil. The outcome was viral suppression, defined as the achievement of the first viral load <50 copies/mL within 12 months after initiating antiretroviral therapy. This outcome was also compared with viral load <1,000 copies/mL and analyzed in two scenarios: intention-to-treat versus per-protocol. Time to viral suppression and adjusted odds ratio accompanied by 95% confidence intervals were estimated. Results Of the 2,599 participants enrolled, 77.5% were men, and the median age was 34 years. In the intention-to-treat analysis, viral suppression was 58.1% for efavirenz and 76.7% for dolutegravir. People living with HIV on dolutegravir-based regimen were more likely to achieve viral suppression (aOR: 2.44; 95%CI: 2.01-2.95) and had a shorter median time to viral suppression (p<0.0001). Antiretroviral therapy initiation within <120 days, baseline CD4⁺T-cells ≥200 cells/mm3, and viral load <100,000 copies/mL had higher odds of viral suppression. According to the per-protocol analysis, viral suppression ≥90% was observed by considering viral load <1,000 copies/mL. Conclusion Our study demonstrated that viral suppression improved after introducing dolutegravir, although the proportion of patients with viral load <50 copies/mL was lower than expected. Improved access to routine viral load examinations and continuous surveillance of the effectiveness of antiretroviral therapy should be considered. |
| first_indexed | 2024-03-13T08:42:50Z |
| format | Article |
| id | doaj.art-24575550accc4eea9cd0dd363e49cea3 |
| institution | Directory Open Access Journal |
| issn | 2317-6385 |
| language | English |
| last_indexed | 2024-03-13T08:42:50Z |
| publishDate | 2023-05-01 |
| publisher | Instituto Israelita de Ensino e Pesquisa Albert Einstein |
| record_format | Article |
| series | Einstein (São Paulo) |
| spelling | doaj.art-24575550accc4eea9cd0dd363e49cea32023-05-30T07:39:20ZengInstituto Israelita de Ensino e Pesquisa Albert EinsteinEinstein (São Paulo)2317-63852023-05-012110.31744/einstein_journal/2023ao0156Suppression of HIV in the first 12 months of antiretroviral therapy: a comparative analysis of dolutegravir- and efavirenz-based regimensGabriella Jomara da Silvahttps://orcid.org/0000-0001-8836-5052Cássia Cristina Pinto Mendicinohttps://orcid.org/0000-0002-1627-292XCristiane Aparecida Menezes de Páduahttps://orcid.org/0000-0001-7083-3188Unaí Tupinambáshttps://orcid.org/0000-0002-3681-4124ABSTRACT Objective To compare viral suppression in treatment-naïve adults starting antiretroviral therapy with dolutegravir (50mg)- and efavirenz (600mg)-based regimens. Methods We analyzed secondary data from Brazilian health information systems of people living with human immunodeficiency virus who started antiretroviral therapy between 2015 and 2017 in Minas Gerais, Brazil. The outcome was viral suppression, defined as the achievement of the first viral load <50 copies/mL within 12 months after initiating antiretroviral therapy. This outcome was also compared with viral load <1,000 copies/mL and analyzed in two scenarios: intention-to-treat versus per-protocol. Time to viral suppression and adjusted odds ratio accompanied by 95% confidence intervals were estimated. Results Of the 2,599 participants enrolled, 77.5% were men, and the median age was 34 years. In the intention-to-treat analysis, viral suppression was 58.1% for efavirenz and 76.7% for dolutegravir. People living with HIV on dolutegravir-based regimen were more likely to achieve viral suppression (aOR: 2.44; 95%CI: 2.01-2.95) and had a shorter median time to viral suppression (p<0.0001). Antiretroviral therapy initiation within <120 days, baseline CD4⁺T-cells ≥200 cells/mm3, and viral load <100,000 copies/mL had higher odds of viral suppression. According to the per-protocol analysis, viral suppression ≥90% was observed by considering viral load <1,000 copies/mL. Conclusion Our study demonstrated that viral suppression improved after introducing dolutegravir, although the proportion of patients with viral load <50 copies/mL was lower than expected. Improved access to routine viral load examinations and continuous surveillance of the effectiveness of antiretroviral therapy should be considered.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1679-45082023000100213&lng=en&tlng=enHIV-1Viral loadSustained virologic responseEffectivenessDolutegravirEfavirenzDrug therapy, combinationAntiretroviral therapy, highly activeAnti-HIV agents |
| spellingShingle | Gabriella Jomara da Silva Cássia Cristina Pinto Mendicino Cristiane Aparecida Menezes de Pádua Unaí Tupinambás Suppression of HIV in the first 12 months of antiretroviral therapy: a comparative analysis of dolutegravir- and efavirenz-based regimens Einstein (São Paulo) HIV-1 Viral load Sustained virologic response Effectiveness Dolutegravir Efavirenz Drug therapy, combination Antiretroviral therapy, highly active Anti-HIV agents |
| title | Suppression of HIV in the first 12 months of antiretroviral therapy: a comparative analysis of dolutegravir- and efavirenz-based regimens |
| title_full | Suppression of HIV in the first 12 months of antiretroviral therapy: a comparative analysis of dolutegravir- and efavirenz-based regimens |
| title_fullStr | Suppression of HIV in the first 12 months of antiretroviral therapy: a comparative analysis of dolutegravir- and efavirenz-based regimens |
| title_full_unstemmed | Suppression of HIV in the first 12 months of antiretroviral therapy: a comparative analysis of dolutegravir- and efavirenz-based regimens |
| title_short | Suppression of HIV in the first 12 months of antiretroviral therapy: a comparative analysis of dolutegravir- and efavirenz-based regimens |
| title_sort | suppression of hiv in the first 12 months of antiretroviral therapy a comparative analysis of dolutegravir and efavirenz based regimens |
| topic | HIV-1 Viral load Sustained virologic response Effectiveness Dolutegravir Efavirenz Drug therapy, combination Antiretroviral therapy, highly active Anti-HIV agents |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1679-45082023000100213&lng=en&tlng=en |
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