Outcomes of severely ill patients with AIDS treated with efavirenz or dolutegravir: a multicenter, observational study
BackgroundCurrently, integrase inhibitors (INIs)-based ART regimens are the preferred initial therapy for AIDS patients. There is scarce information on the use of dolutegravir (DTG) among late-presenter people living with HIV (PLHIV).ObjectivesTo compare the effect of DTG- or efavirenz (EFV)-based r...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-02-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2024.1302710/full |
| _version_ | 1797292541178019840 |
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| author | Carlos Brites Marcus Lacerda Eduardo Sprinz Monica Bay Gustavo Pinto Pollyanna Azevedo Estela Luz Liliane Lins-Kusterer Eduardo M. Netto |
| author_facet | Carlos Brites Marcus Lacerda Eduardo Sprinz Monica Bay Gustavo Pinto Pollyanna Azevedo Estela Luz Liliane Lins-Kusterer Eduardo M. Netto |
| author_sort | Carlos Brites |
| collection | DOAJ |
| description | BackgroundCurrently, integrase inhibitors (INIs)-based ART regimens are the preferred initial therapy for AIDS patients. There is scarce information on the use of dolutegravir (DTG) among late-presenter people living with HIV (PLHIV).ObjectivesTo compare the effect of DTG- or efavirenz (EFV)-based regimens on the outcomes of patients with advanced AIDS.MethodsWe compared two cohorts of consecutive symptomatic AIDS patients (WHO stage 4, CD4 count<50 cells/mL) starting therapy with DTG-based (2018–2021, prospective cohort) or EFV-based regimens (2013–2016, retrospective cohort) from five Brazilian cities. The main endpoints were early (all-cause) mortality, viral suppression at 24 and 48 weeks, changes in CD4 count, and changes in initial therapy (for any reason).ResultsWe included all eligible patients in a consecutive way (in both groups) until we reached 92 individuals per arm. The median baseline CD4 count (20 vs. 21 cells/mL) and the median HIV plasma viral load (5.5 copies/mL log10) were identical across the groups. Viral suppression rates were higher in the DTG group than in the EFV group at 24 (67.4% vs. 42.4%,) and 48 weeks (65.2% vs. 45.7%, p < 0.001 for both comparisons). More patients in the DTG group presented with CD4 > 200 cells/mL compared to the EFV group at 48 weeks (45% vs. 29%, p = 0.03). Treatment changes (ITT, M = F) were significantly more frequent in the EFV group (1% vs. 17%, p < 0.0001). The relative mortality rate was 25% lower in the DTG group, but without statistical significance.ConclusionWe detected a higher rate of virological suppression and greater treatment durability in patients with advanced AIDS treated with DTG than in those treated with EFV. |
| first_indexed | 2024-03-07T19:57:56Z |
| format | Article |
| id | doaj.art-45982b7e9171492da864fc0d14e04429 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-03-07T19:57:56Z |
| publishDate | 2024-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-45982b7e9171492da864fc0d14e044292024-02-28T12:45:59ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2024-02-011110.3389/fmed.2024.13027101302710Outcomes of severely ill patients with AIDS treated with efavirenz or dolutegravir: a multicenter, observational studyCarlos Brites0Marcus Lacerda1Eduardo Sprinz2Monica Bay3Gustavo Pinto4Pollyanna Azevedo5Estela Luz6Liliane Lins-Kusterer7Eduardo M. Netto8Laboratório de Pesquisa em Infectologia, Department of Medicine, Hospital Universitário Professor Edgard Santos - EBSERH, Federal University of Bahia, Salvador, BrazilFundação de Medicina Tropical de Manaus, Manaus, BrazilHospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, BrazilFederal University of Rio Grande do Norte, Natal, BrazilFederal University of Santa Catarina, Florianópolis, BrazilLaboratório de Pesquisa em Infectologia, Department of Medicine, Hospital Universitário Professor Edgard Santos - EBSERH, Federal University of Bahia, Salvador, BrazilLaboratório de Pesquisa em Infectologia, Department of Medicine, Hospital Universitário Professor Edgard Santos - EBSERH, Federal University of Bahia, Salvador, BrazilLaboratório de Pesquisa em Infectologia, Department of Medicine, Hospital Universitário Professor Edgard Santos - EBSERH, Federal University of Bahia, Salvador, BrazilLaboratório de Pesquisa em Infectologia, Department of Medicine, Hospital Universitário Professor Edgard Santos - EBSERH, Federal University of Bahia, Salvador, BrazilBackgroundCurrently, integrase inhibitors (INIs)-based ART regimens are the preferred initial therapy for AIDS patients. There is scarce information on the use of dolutegravir (DTG) among late-presenter people living with HIV (PLHIV).ObjectivesTo compare the effect of DTG- or efavirenz (EFV)-based regimens on the outcomes of patients with advanced AIDS.MethodsWe compared two cohorts of consecutive symptomatic AIDS patients (WHO stage 4, CD4 count<50 cells/mL) starting therapy with DTG-based (2018–2021, prospective cohort) or EFV-based regimens (2013–2016, retrospective cohort) from five Brazilian cities. The main endpoints were early (all-cause) mortality, viral suppression at 24 and 48 weeks, changes in CD4 count, and changes in initial therapy (for any reason).ResultsWe included all eligible patients in a consecutive way (in both groups) until we reached 92 individuals per arm. The median baseline CD4 count (20 vs. 21 cells/mL) and the median HIV plasma viral load (5.5 copies/mL log10) were identical across the groups. Viral suppression rates were higher in the DTG group than in the EFV group at 24 (67.4% vs. 42.4%,) and 48 weeks (65.2% vs. 45.7%, p < 0.001 for both comparisons). More patients in the DTG group presented with CD4 > 200 cells/mL compared to the EFV group at 48 weeks (45% vs. 29%, p = 0.03). Treatment changes (ITT, M = F) were significantly more frequent in the EFV group (1% vs. 17%, p < 0.0001). The relative mortality rate was 25% lower in the DTG group, but without statistical significance.ConclusionWe detected a higher rate of virological suppression and greater treatment durability in patients with advanced AIDS treated with DTG than in those treated with EFV.https://www.frontiersin.org/articles/10.3389/fmed.2024.1302710/fullearly mortalityadvanced AIDSdolutegravirefavirenzadverse (side) effects |
| spellingShingle | Carlos Brites Marcus Lacerda Eduardo Sprinz Monica Bay Gustavo Pinto Pollyanna Azevedo Estela Luz Liliane Lins-Kusterer Eduardo M. Netto Outcomes of severely ill patients with AIDS treated with efavirenz or dolutegravir: a multicenter, observational study Frontiers in Medicine early mortality advanced AIDS dolutegravir efavirenz adverse (side) effects |
| title | Outcomes of severely ill patients with AIDS treated with efavirenz or dolutegravir: a multicenter, observational study |
| title_full | Outcomes of severely ill patients with AIDS treated with efavirenz or dolutegravir: a multicenter, observational study |
| title_fullStr | Outcomes of severely ill patients with AIDS treated with efavirenz or dolutegravir: a multicenter, observational study |
| title_full_unstemmed | Outcomes of severely ill patients with AIDS treated with efavirenz or dolutegravir: a multicenter, observational study |
| title_short | Outcomes of severely ill patients with AIDS treated with efavirenz or dolutegravir: a multicenter, observational study |
| title_sort | outcomes of severely ill patients with aids treated with efavirenz or dolutegravir a multicenter observational study |
| topic | early mortality advanced AIDS dolutegravir efavirenz adverse (side) effects |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2024.1302710/full |
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