Preprint
Uptake and 24-month outcomes of dolutegravir- versus lopinavir-based second-line antiretroviral therapy for people with HIV in South Africa: a retrospective cohort study and emulated target trial
- Abstract:
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Background
Aligning with the WHO, South Africa has replaced LPV/r with DTG in second-line ART after treatment failure with TDF/XTC/EFV. Initial guidance included special considerations for DTG use among women.
MethodsWe analysed routine de-identified data of adults switched from TDF/XTC/EFV to second-line AZT/XTC/LPV/r, AZT/XTC/DTG, or TDF/XTC/DTG between December 2019 and December 2023 at 108 healthcare facilities in KwaZulu-Natal, South Africa. Among people switched before July 2021, we emulated a target trial comparing 24-month death or loss to follow-up (LTFU), and viraemia (>50 copies/mL). We conducted intention-to-treat and per-protocol analyses using weighted logistic regression with bootstrapped CIs.
ResultsOverall, women were less likely than men to switch to DTG (RR: 0.92 [95% CI: 0.88, 0.96]; N=3649). Of 2321 people switched before July 2021, 915 (39%) switched to AZT/XTC/LPV/r, 415 (18%) to AZT/XTC/DTG, and 991 (43%) to TDF/XTC/DTG. Median age was 36 years (IQR: 30, 43) and 1364 (59%) were women. In intention-to-treat analyses, the standardised 24-month risk of death or LTFU was similar with AZT/XTC/LPV/r (31%), AZT/XTC/DTG (30%), and TDF/XTC/DTG (34%). The standardised risk of 24-month viraemia among those retained in care with a viral load result (N=1270) was higher with AZT/XTC/LPV/r (49%) than with AZT/XTC/DTG (39%; aRD: -11% [95% CI -17%, -4%]) or TDF/XTC/DTG (38%; aRD: -11% [95% CI -17%, -4%]). Per-protocol analyses gave similar results.
ConclusionsWhile retention was similar across regimens, viraemia was less common on DTG-based ART, supporting current guidelines.
- Publication status:
- Published
- Peer review status:
- Not peer reviewed
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(Preview, Pre-print, pdf, 471.7KB, Terms of use)
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- Preprint server copy:
- 10.12688/verixiv.686.1
Authors
- Funder identifier:
- https://ror.org/0456r8d26
- Grant:
- INV-051067
- Funder identifier:
- https://ror.org/00yjd3n13
- Grant:
- 221966
- Funder identifier:
- https://ror.org/0187kwz08
- Grant:
- CL-2022–13–005
- Preprint server:
- VeriXiv
- Publication date:
- 2025-03-09
- DOI:
- EISSN:
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3029-0988
- Server owner:
- F1000 Research
- Language:
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English
- Keywords:
- Pubs id:
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2094272
- Local pid:
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pubs:2094272
- Deposit date:
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2026-05-29
- ARK identifier:
Terms of use
- Copyright holder:
- Brown et al
- Copyright date:
- 2025
- Rights statement:
- © 2025 Brown JA et al. This is an open access work distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
- Licence:
- CC Attribution (CC BY)
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