Real-world use and outcomes of dolutegravir-containing antiretroviral therapy in HIV and tuberculosis co-infection: a site survey and cohort study in sub-Saharan Africa.

Autor: Romo ML; Department of Epidemiology and Biostatistics & Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA., Brazier E; Department of Epidemiology and Biostatistics & Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA., Mahambou-Nsondé D; Centre de traitement ambulatoire de Brazzaville, enceinte CHU de Brazzaville, Brazzaville, Congo., De Waal R; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa., Sekaggya-Wiltshire C; Infectious Diseases Institute, Makerere University, Kampala, Uganda., Chimbetete C; Newlands Clinic, Harare, Zimbabwe., Muyindike WR; Department of Internal Medicine, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda., Murenzi G; Research for Development (RD Rwanda) and Rwanda Military Hospital, Kigali, Rwanda., Kunzekwenyika C; SolidarMed, Masvingo, Zimbabwe., Tiendrebeogo T; University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux Population Health Research Center, Bordeaux, France., Muhairwe JA; SolidarMed, Maseru, Lesotho., Lelo P; Kalembelembe Pediatric Hospital, Kinshasa, Democratic Republic of the Congo., Dzudie A; Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon., Twizere C; Centre National de Référence en matière de VIH/SIDA (CNR), Bujumbura, Burundi., Rafael I; SolidarMed, Ancuabe, Mozambique., Ezechi OC; Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria., Diero L; School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya., Yotebieng M; Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA., Fenner L; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland., Wools-Kaloustian KK; Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA., Shah NS; Division of Infectious Diseases, Emory University School of Medicine & Emory University Rollins School of Public Health, Atlanta, Georgia, USA., Nash D; Department of Epidemiology and Biostatistics & Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA.
Jazyk: angličtina
Zdroj: Journal of the International AIDS Society [J Int AIDS Soc] 2022 Jul; Vol. 25 (7), pp. e25961.
DOI: 10.1002/jia2.25961
Abstrakt: Introduction: Dolutegravir is being scaled up globally as part of antiretroviral therapy (ART), but for people with HIV and tuberculosis co-infection, its use is complicated by a drug-drug interaction with rifampicin requiring an additional daily dose of dolutegravir. This represents a disadvantage over efavirenz, which does not have a major drug-drug interaction with rifampicin. We sought to describe HIV clinic practices for prescribing concomitant dolutegravir and rifampicin, and characterize virologic outcomes among patients with tuberculosis co-infection receiving dolutegravir or efavirenz.
Methods: Within the four sub-Saharan Africa regions of the International epidemiology Databases to Evaluate AIDS consortium, we conducted a site survey (2021) and a cohort study (2015-2021). The cohort study used routine clinical data and included patients newly initiating or already receiving dolutegravir or efavirenz at the time of tuberculosis diagnosis. Patients were followed from tuberculosis diagnosis until viral suppression (<1000 copies/ml), a competing event (switching ART regimen; loss to program/death) or administrative censoring at 12 months.
Results: In the survey, 86 of 90 (96%) HIV clinics in 18 countries reported prescribing dolutegravir to patients who were receiving rifampicin as part of tuberculosis treatment, with 77 (90%) reporting that they use twice-daily dosing of dolutegravir, of which 74 (96%) reported having 50 mg tablets available to accommodate twice-daily dosing. The cohort study included 3563 patients in 11 countries, with 67% newly or recently initiating ART. Among patients receiving dolutegravir (n = 465), the cumulative incidence of viral suppression was 58.9% (95% confidence interval [CI]: 54.3-63.3%), switching ART regimen was 4.1% (95% CI: 2.6-6.2%) and loss to program/death was 23.4% (95% CI: 19.7-27.4%). Patients receiving dolutegravir had improved viral suppression compared with patients receiving efavirenz who had a tuberculosis diagnosis before site dolutegravir availability (adjusted subdistribution hazard ratio [aSHR]: 1.47, 95% CI: 1.28-1.68) and after site dolutegravir availability (aSHR 1.28, 95% CI: 1.08-1.51).
Conclusions: At a programmatic level, dolutegravir was being widely prescribed in sub-Saharan Africa for people with HIV and tuberculosis co-infection with a dose adjustment for the drug-drug interaction with rifampicin. Despite this more complex regimen, our cohort study revealed that dolutegravir did not negatively impact viral suppression.
(© 2022 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.)
Databáze: MEDLINE
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