杜鲁替韦与依非韦伦对6个月病毒抑制和滞留的影响:一个回归不连续设计。

IF 2.9 3区 医学 Q3 IMMUNOLOGY
Amy Zheng, Matthew P Fox, Ross Greener, Emma M Kileel, Jacob Bor, Willem D F Venter, Pedro T Pisa, Alana T Brennan, Mhairi Maskew
{"title":"杜鲁替韦与依非韦伦对6个月病毒抑制和滞留的影响:一个回归不连续设计。","authors":"Amy Zheng, Matthew P Fox, Ross Greener, Emma M Kileel, Jacob Bor, Willem D F Venter, Pedro T Pisa, Alana T Brennan, Mhairi Maskew","doi":"10.1097/QAI.0000000000003642","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In 2019, South Africa's Antiretroviral Therapy (ART) Treatment Guidelines replaced efavirenz with dolutegravir in first-line ART.</p><p><strong>Setting: </strong>We assessed the impact of this national guideline change on retention and viral suppression in the Themba Lethu Clinical Cohort, Johannesburg, South Africa. We applied a regression discontinuity design in a prospective cohort study of 1654 adults living with HIV initiating first-line ART within 12 months (±12 months) of the guideline change.</p><p><strong>Methods: </strong>We compared outcomes in individuals presenting just before and after the guideline change and estimated intention-to-treat effects on initiating a dolutegravir- vs efavirenz-based regimen. Primary outcomes were retention and viral suppression. Participants were defined as retained in care if a visit took place within ±3 months of the 6-month end point. Viral suppression was defined as having a viral load ≤1000 copies/mL 3 months before and up to 6 months after the 6-month end point.</p><p><strong>Results: </strong>The 2019 guideline change led to an increase in uptake of dolutegravir. We noted a 26.6 percentage point increase in the proportion initiating dolutegravir [95% Confidence Interval (CI): 14.1 to 38.6]. We saw a small increase in viral suppression [Risk Difference (RD): 7.4 percentage points; 95% CI: -1.6 to 16.5] and no change in retention (RD: -1.7 percentage points; 95% CI: -13.9 to 10.5) at 6 months, though our findings were imprecise.</p><p><strong>Conclusions: </strong>Our estimates suggest early uptake of the revised treatment guidelines after implementation. Despite this, there was no meaningful change in viral suppression and retention rates at 6 months.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"151-157"},"PeriodicalIF":2.9000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129560/pdf/","citationCount":"0","resultStr":"{\"title\":\"Initiation of Dolutegravir Versus Efavirenz on Viral Suppression and Retention at 6 months: A Regression Discontinuity Design.\",\"authors\":\"Amy Zheng, Matthew P Fox, Ross Greener, Emma M Kileel, Jacob Bor, Willem D F Venter, Pedro T Pisa, Alana T Brennan, Mhairi Maskew\",\"doi\":\"10.1097/QAI.0000000000003642\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In 2019, South Africa's Antiretroviral Therapy (ART) Treatment Guidelines replaced efavirenz with dolutegravir in first-line ART.</p><p><strong>Setting: </strong>We assessed the impact of this national guideline change on retention and viral suppression in the Themba Lethu Clinical Cohort, Johannesburg, South Africa. We applied a regression discontinuity design in a prospective cohort study of 1654 adults living with HIV initiating first-line ART within 12 months (±12 months) of the guideline change.</p><p><strong>Methods: </strong>We compared outcomes in individuals presenting just before and after the guideline change and estimated intention-to-treat effects on initiating a dolutegravir- vs efavirenz-based regimen. Primary outcomes were retention and viral suppression. Participants were defined as retained in care if a visit took place within ±3 months of the 6-month end point. Viral suppression was defined as having a viral load ≤1000 copies/mL 3 months before and up to 6 months after the 6-month end point.</p><p><strong>Results: </strong>The 2019 guideline change led to an increase in uptake of dolutegravir. We noted a 26.6 percentage point increase in the proportion initiating dolutegravir [95% Confidence Interval (CI): 14.1 to 38.6]. We saw a small increase in viral suppression [Risk Difference (RD): 7.4 percentage points; 95% CI: -1.6 to 16.5] and no change in retention (RD: -1.7 percentage points; 95% CI: -13.9 to 10.5) at 6 months, though our findings were imprecise.</p><p><strong>Conclusions: </strong>Our estimates suggest early uptake of the revised treatment guidelines after implementation. Despite this, there was no meaningful change in viral suppression and retention rates at 6 months.</p>\",\"PeriodicalId\":14588,\"journal\":{\"name\":\"JAIDS Journal of Acquired Immune Deficiency Syndromes\",\"volume\":\" \",\"pages\":\"151-157\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129560/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JAIDS Journal of Acquired Immune Deficiency Syndromes\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/QAI.0000000000003642\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAIDS Journal of Acquired Immune Deficiency Syndromes","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/QAI.0000000000003642","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
引用次数: 0

摘要

背景:2019年,南非的抗逆转录病毒治疗(ART)治疗指南在一线抗逆转录病毒治疗中用多替格拉韦取代了依非韦伦。背景:我们在南非约翰内斯堡的Themba Lethu临床队列中评估了这一国家指南变化对病毒滞留和病毒抑制的影响。我们在一项前瞻性队列研究中应用了回归不连续设计,该研究纳入了1654名艾滋病毒感染者,他们在指南改变后的12个月内(±12个月)开始接受一线抗逆转录病毒治疗。方法:我们比较了在指南改变之前和之后出现的个体的结果,并估计了开始以多替格拉韦和依非韦伦为基础的方案的意向治疗效果。主要结局是滞留和病毒抑制。如果在6个月终点的+3个月内进行了访问,则将参与者定义为保留护理。病毒抑制被定义为在6个月终点前3个月和6个月终点后6个月的病毒载量< 1000拷贝/mL。结果:2019年指南的变化导致了多替韦的摄入量增加。我们注意到开始使用多替韦的比例增加了26.6个百分点(95%置信区间(CI): 14.1, 38.6)。我们发现病毒抑制略有增加(风险差异(RD): 7.4个百分点;95% CI: -1.6, 16.5),保留率无变化(RD: -1.7个百分点;6个月时95% CI: -13.9, 10.5),尽管我们的发现并不精确。结论:我们的估计建议在实施修订后的治疗指南后尽早接受。尽管如此,在6个月时,病毒抑制和保留率没有明显变化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Initiation of Dolutegravir Versus Efavirenz on Viral Suppression and Retention at 6 months: A Regression Discontinuity Design.

Background: In 2019, South Africa's Antiretroviral Therapy (ART) Treatment Guidelines replaced efavirenz with dolutegravir in first-line ART.

Setting: We assessed the impact of this national guideline change on retention and viral suppression in the Themba Lethu Clinical Cohort, Johannesburg, South Africa. We applied a regression discontinuity design in a prospective cohort study of 1654 adults living with HIV initiating first-line ART within 12 months (±12 months) of the guideline change.

Methods: We compared outcomes in individuals presenting just before and after the guideline change and estimated intention-to-treat effects on initiating a dolutegravir- vs efavirenz-based regimen. Primary outcomes were retention and viral suppression. Participants were defined as retained in care if a visit took place within ±3 months of the 6-month end point. Viral suppression was defined as having a viral load ≤1000 copies/mL 3 months before and up to 6 months after the 6-month end point.

Results: The 2019 guideline change led to an increase in uptake of dolutegravir. We noted a 26.6 percentage point increase in the proportion initiating dolutegravir [95% Confidence Interval (CI): 14.1 to 38.6]. We saw a small increase in viral suppression [Risk Difference (RD): 7.4 percentage points; 95% CI: -1.6 to 16.5] and no change in retention (RD: -1.7 percentage points; 95% CI: -13.9 to 10.5) at 6 months, though our findings were imprecise.

Conclusions: Our estimates suggest early uptake of the revised treatment guidelines after implementation. Despite this, there was no meaningful change in viral suppression and retention rates at 6 months.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
5.80
自引率
5.60%
发文量
490
审稿时长
3-6 weeks
期刊介绍: JAIDS: Journal of Acquired Immune Deficiency Syndromes​ seeks to end the HIV epidemic by presenting important new science across all disciplines that advance our understanding of the biology, treatment and prevention of HIV infection worldwide. JAIDS: Journal of Acquired Immune Deficiency Syndromes is the trusted, interdisciplinary resource for HIV- and AIDS-related information with a strong focus on basic and translational science, clinical science, and epidemiology and prevention. Co-edited by the foremost leaders in clinical virology, molecular biology, and epidemiology, JAIDS publishes vital information on the advances in diagnosis and treatment of HIV infections, as well as the latest research in the development of therapeutics and vaccine approaches. This ground-breaking journal brings together rigorously peer-reviewed articles, reviews of current research, results of clinical trials, and epidemiologic reports from around the world.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信