Journal article
Clinical outcomes after Viremia among people receiving dolutegravir vs efavirenz-based first-line antiretroviral therapy in South Africa
- Abstract:
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Background
We aimed to compare clinical outcomes after viremia between dolutegravir vs 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 with HIV aged ≥15 years receiving first-line tenofovir disoproxil fumarate, lamivudine, dolutegravir (TLD) or tenofovir disoproxil fumarate, emtricitabine, efavirenz (TEE) and with first viremia (≥50 copies/mL) between June and 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 vs TEE.
Results
At first viremia, among 9657 participants, 6457 (66.9%) were female, and the median age (interquartile range [IQR]) was 37 (31–44) years; 7598 (78.7%) were receiving TEE and 2059 (21.3%) TLD. Retention in care was slightly 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 with a 12-month viral load, viral suppression was similar between the 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 a 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 (78.9%) than TEE (74.9%) group (aRR, 1.07; 95% CI, 1.03–1.12).
Conclusions
Among people with viremia on first-line ART, dolutegravir was associated with slightly better retention in care and similar or better viral suppression than efavirenz.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 559.9KB, Terms of use)
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- Publisher copy:
- 10.1093/ofid/ofad583
Authors
- Publisher:
- Oxford University Press
- Journal:
- Open Forum Infectious Diseases More from this journal
- Volume:
- 10
- Issue:
- 12
- Article number:
- ofad583
- Place of publication:
- United States
- Publication date:
- 2023-11-16
- Acceptance date:
- 2023-11-15
- DOI:
- EISSN:
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2328-8957
- Pmid:
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38045558
- Language:
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English
- Keywords:
- Pubs id:
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1577903
- Local pid:
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pubs:1577903
- Deposit date:
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2023-12-08
Terms of use
- Copyright holder:
- Asare et al.
- Copyright date:
- 2023
- Rights statement:
- © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
- Licence:
- CC Attribution (CC BY)
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