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.
Jennifer Anne Brown, Lara Lewis, Yukteshwar Sookrajh, Lungile Hobe, Thulani Ngwenya, Johan van der Molen, Kwabena Asare, Kwena Tlhaku, Mlungisi Khanyile, Thokozani Khubone, Christian Bottomley, Nigel Garrett, Jienchi Dorward
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引用次数: 0
Abstract
Background: Aligning with the World Health Organization, South Africa has replaced ritonavir-boosted lopinavir (LPV/r) with dolutegravir (DTG) in second-line antiretroviral therapy (ART) after treatment failure with tenofovir disoproxil fumarate (TDF)/lamivudine or emtricitabine (XTC)/efavirenz (EFV). Initial guidance included special considerations for DTG use among women.
Methods: We analyzed routine deidentified 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 viremia (>50 copies/mL). We conducted intention-to-treat and per-protocol analyses using weighted logistic regression with bootstrapped CIs.
Results: Overall, women were less likely than men to switch to DTG (RR: 0.92 [95% CI: .88, .96]; N = 3649). Of 2321 people switched before July 2021, 915 (39%) switched to AZT/XTC/LPV/r, 415 (18%) to zidovudine (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 standardized 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 standardized risk of 24-month viremia among those retained in care with a viral load result (N = 1270) was higher with AZT/XTC/LPV/r (50%) than with AZT/XTC/DTG (40%; aRD: -10% [95% CI -19%, -2%]) or TDF/XTC/DTG (39%; aRD: -11% [95% CI -18%, -5%]). Per-protocol analyses gave similar results.
Conclusions: While retention was similar across regimens, viremia was less common on DTG-based ART, supporting current guidelines.
期刊介绍：
Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.
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