학술논문
Viral Load Status Before Switching to Dolutegravir-Containing Antiretroviral Therapy and Associations With Human Immunodeficiency Virus Treatment Outcomes in Sub-Saharan Africa.
Document Type
Article
Author
Romo, Matthew L; Edwards, Jessie K; Semeere, Aggrey S; Musick, Beverly S; Urassa, Mark; Odhiambo, Francesca; Diero, Lameck; Kasozi, Charles; Murenzi, Gad; Lelo, Patricia; Wyka, Katarzyna; Kelvin, Elizabeth A; Sohn, Annette H; Wools-Kaloustian, Kara K; Nash, Denis; (IeDEA), International epidemiology Databases to Evaluate AIDS
Source
Subject
*HIV infection prognosis
*HIV infections
*PUBLIC health surveillance
*CONFIDENCE intervals
*HIV integrase inhibitors
*VIRAL load
*MULTIVARIATE analysis
*REGRESSION analysis
*HIGHLY active antiretroviral therapy
*TREATMENT effectiveness
*PATIENT monitoring
*TUBERCULOSIS
*DESCRIPTIVE statistics
*DECISION making in clinical medicine
*DATA analysis software
*PROPORTIONAL hazards models
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Language
ISSN
1058-4838
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. [ABSTRACT FROM AUTHOR]