Preprint
Clinical outcomes after viraemia among people receiving dolutegravir versus efavirenz-based first-line antiretroviral therapy in South Africa
- Abstract:
-
Introduction We aimed to compare clinical outcomes after viraemia between dolutegravir versus efavirenz-based first-line antiretroviral therapy (ART) as evidence is lacking outside clinical trials in resource-limited settings.
Methods We conducted a retrospective cohort analysis with routine data from 59 South African clinics. We included people living with HIV ≥15 years old receiving first-line tenofovir disoproxil fumarate, lamivudine, dolutegravir (TLD) or tenofovir disoproxil fumarate, emtricitabine, efavirenz (TEE), and with first viraemia (≥50 copies/ml) between June to November 2020. We used multivariable modified Poisson regression models to compare retention-in-care and viral suppression (<50 copies/ml) after 12 months between participants on TLD versus TEE.
Results At first viraemia, among 9657 participants, 6457 (66.9%) were female, median age was 37 years (interquartile range [IQR] 31-44); 7598 (78.7%) were receiving TEE and 2059 (21.3%) TLD. Retention-in-care was higher in the TLD group (84.9%) than TEE (80.8%), adjusted risk ratio (aRR) 1.03, 95%CI 1.00-1.06. Of 6569 participants retained in care and had a 12-month viral load, viral suppression was similar between TLD (78.9%) and TEE (78.8%) groups, aRR 1.02, 95%CI 0.98-1.05. However, 3368 participants changed ART during follow-up; the majority from TEE to first-line TLD (89.1%) or second-line (TLD 3.4%, zidovudine/emtricitabine/lopinavir-ritonavir 2.1%). In sensitivity analysis among the remaining 3980 participants who did not change ART during follow-up and had a 12-month viral load, viral suppression was higher in the TLD group (78.9%) than TEE (74.9%), aRR 1.07, 95%CI 1.03-1.12.
Conclusions Among people with viraemia on first-line ART, dolutegravir was associated with better retention-in-care and similar or better viral suppression than efavirenz.
- Publication status:
- Published
- Peer review status:
- Not peer reviewed
Actions
Access Document
- Files:
-
-
(Preview, Pre-print, pdf, 280.5KB, Terms of use)
-
- Preprint server copy:
- 10.1101/2023.08.15.23293965
Authors
- Funder identifier:
- https://ror.org/0187kwz08
- Grant:
- CL-2022-13-005
- Preprint server:
- medRxiv
- Publication date:
- 2023-08-21
- DOI:
- Language:
-
English
- Keywords:
- Pubs id:
-
1714159
- Local pid:
-
pubs:1714159
- Deposit date:
-
2026-05-29
- ARK identifier:
Terms of use
- Copyright holder:
- Asare et al
- Copyright date:
- 2023
- Rights statement:
- ©2023 The Authors. The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission.
If you are the owner of this record, you can report an update to it here: Report update to this record