Comparative Safety and Survival Rate of Dolutegravir with Efavirenz based Antiretroviral Therapies for First-line HIV Treatment among Patients in Amhara Region, Ethiopia: Retrospective Cohort Study.
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Date
2022-02
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Addis Ababa University
Abstract
Background: In combination with other two anti retroviral drugs,Efavirenz(EFV) was the treatment of choice for human immuno deficiency virus(HIV) infection.Given concern sabout safety and resistance,dolutegravir(DTG)-based regimen have been considered as preferred first-line treatments for both treatment naive and treatment experienced HIV patents.
Objective:To determine the safety and survival rate of DTG compared with EFV-based anti retro viral therapies as first-line HIV treatment among HIV patients.
Objective: To determine the safety and survival rate of DTG compared with EFV-based
antiretroviral therapies as first-line HIV treatment among HIV patients.
Methods: A retrospective hospital-based cohort study carried out from September 1, 2019
to August 30, 2020 at HIV clinics of three selected hospitals with HIV treatment centers in
Amhara region, Ethiopia. All HIV patients ≥3 years old, those had been either on DTG or
EFV-based combination anti-retroviral therapy (cART), and had detectable VL were
included. All HIV patients who fulfill inclusion criteria were studied. Data was extracted
from patient chart using structure questionnaire. Descriptive statistics, chi-square test,
univariate and multivariate cox-regression were performed for data analysis. A statistical
significance was considered at p-value ≤ 0.05.
Result: Overall, 990 HIV patients were included in the analysis of which 694 took DTG
and 296 received EFV based-regimen. A viral load of < 50 copies/mL was observed in 479
of 694 participants (69%) in the DTG group and 196 of 296 participants (66%) in the EFV
group (AHR=1.28, 95%CI: 1.08-1.51; p=0.004).Among patients with a baseline viral load
of ≥1000 copies/ mL, a total of 66 from 174 participants (38.0%) in the DTG group and 35
out of 96 participants (36.5%) in the EFV group had a viral load of <50 copies/mL
(AHR=0.45, 95%CI: 0.37-0.56; p<0.001). Eleven (1.6%) patients in the DTG group and 8
(2.7%) patients in the EFV group showed virologic failure (p=0.241).Out of the total, 289
(42%) of patients in the DTG group reported adverse drug event (ADE) compared with 147
(50%) in the EFV group (p=0.020).Younger age, opportunistic infections (OI), bedridden
condition, no prophylaxis for OI, low baseline cluster differentiation (CD4), high baseline
viral load, poor adherence and ADE were predictors of poor survival and also younger age,
OI, low baseline CD4, DTG-based initial regimen, poor adherence for cART, naïve
treatment history and student job type were predictor of poor safety outcomes.
Conclusions: DTG-based regimen demonstrates improved survival rate and good safety
profile than EFV-based regimen for the treatment of HIV infected patients. Baseline CD4+
T-cell count < 200 cells/mm3, opportunistic infections and poor adherence were factors
associated with poor survival outcome and safety outcomes. HIV patients with these risk
factors should be treated and monitored regularly
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Keywords
Dolutegravir,Efavirenz,Humanimmunodeficiencyvirus,Safety,Survival.