Viral Load Status Before Switching to Dolutegravir-Containing Antiretroviral Therapy and Associations With Human Immunodeficiency Virus Treatment Outcomes in Sub-Saharan Africa
Year: 2021
Type: article
Abstract: BACKGROUND: Dolutegravir is being rolled out globally as part of preferred antiretroviral therapy (ART) regimens, including among treatment-experienced patients. The role of viral load (VL) testing before switching patients already on ART to a dolutegravir-containing regimen is less clear in real-world settings. METHODS: We included patients from the International epidemiology Databases to Evaluate AIDS consortium who switched from a nevirapine- or efavirenz-containing regimen to one with dolutegravir. We used multivariable cause-specific hazards regression to estimate the association of the most recent VL test in the 12 months before switching with subsequent outcomes. RESULTS: We included 36 393 patients at 37 sites in 5 countries (Democratic Republic of the Congo, Kenya, Rwanda, Tanzania, Uganda) who switched to dolutegravir from July 2017 through February 2020, with a median follow-up of approximately 11 months. Compared with those who switched with a VL <200 copies/mL, patients without a recent VL test or with a preswitch VL ≥1000 copies/mL had significantly increased hazards of an incident VL ≥1000 copies/mL (adjusted hazard ratio [aHR], 2.89; 95% confidence interval [CI], 1.99-4.19 and aHR, 6.60; 95% CI, 4.36-9.99, respectively) and pulmonary tuberculosis or a World Health Organization clinical stage 4 event (aHR, 4.78; 95% CI, 2.77-8.24 and aHR, 13.97; 95% CI, 6.62-29.50, respectively). CONCLUSIONS: A VL test before switching to dolutegravir may help identify patients who need additional clinical monitoring and/or adherence support. Further surveillance of patients who switched to dolutegravir with an unknown or unsuppressed VL is needed.
Source: Clinical Infectious Diseases
DOI: 10.1093/cid/ciab1006
Authors: Matthew L Romo, Jessie K Edwards, Aggrey S Semeere, Beverly S Musick, Mark Urassa, Francesca Odhiambo, Lameck Diero, Charles Kasozi, Gad Murenzi, Patricia Lelo, Katarzyna Wyka, Elizabeth A Kelvin, Annette H Sohn, Kara K Wools-Kaloustian, Denis Nash, International epidemiology Databases to Evaluate AIDS (IeDEA)
Institutions: City University of New York, CUNY Graduate School of Public Health and Health Policy, University of North Carolina at Chapel Hill, Infectious Diseases Institute, Makerere University, Indiana University Indianapolis, Indiana University School of Medicine, National Institute for Medical Research, Kenya Medical Research Institute, Moi University, Masaka Hospital, Rwanda Military Hospital, American Foundation for AIDS Research
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Eli Lilly and Company, National Institutes of Health, Centers for Disease Control and Prevention, Office of the Director, National Institute on Alcohol Abuse and Alcoholism, National Heart, Lung, and Blood Institute, National Institute on Drug Abuse, National Cancer Institute, National Institute of Allergy and Infectious Diseases, Fogarty International Center, National Institute of Diabetes and Digestive and Kidney Diseases, U.S. National Library of Medicine, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G2112042590, G3225164166, G6198892570, Central Africa International Epidemiology databases to Evaluate AIDS, Harmonist: A Scalable Toolkit for Standardizing and Coordinating Data Sharing Across International Research Networks, East Africa International Epidemiology Database to evaluate AIDS (IeDEA) Regional Consortium
OpenAlex ID: W4200582160