Professor University of Lagos Nigeria University of Lagos Advisee/Mentor, Nigeria
Background: Notwithstanding the undeniable progress accomplished with the Antiretroviral Therapy, few patients are still unable to achieve virologic suppression due to concerns about safety and efficacy. Dolutegravir-based regimen was recently adopted in Nigeria as first-line treatment for ART-naïve PLWH. However, data are sparse about its safety and efficacy in the Nigerian population to justify its use as replacement for other regimens.
Objectives: This study was aimed at comparing the efficacy and safety of dolutegravir (DTG)- and efavirenz (EFV)-based antiretroviral regimens.
Methods:
Design: The study was a retrospective observational study in the cohorts of treatment naïve individuals at the point of entry into ART programme and started on either DTG- or EFV-based regimen between 30- and 36-month study period.
Setting: Electronic medical records containing sociodemographic, clinical, treatments, hematologic, and viral load data of PLWH who were enrolled into the HIV treatment program at the Centre for Integrated Health Programs (CIHP), Lagos University Teaching Hospital (LUTH) were extracted and retrospectively analyzed.
Exposures: The study will compare efficacy and safety of the two regimens , dolutegravir (DTG)- and efavirenz (EFV)-based antiretroviral regimens. in PLWH by analyzing and evaluating existing data with specifics on proportion of patients with viral load suppression (VLS) < 50 copies/ml, log10 drop Viral Load, change in CD4 from baseline, adverse events (AEs), adherence and drug-drug interaction (DDI).
Results: More patients on DTG-based ART significantly had better HIV-1 RNA VLS, better log drop in VL, fewer adverse events compared to EFV-base regimen. Adherence, percentage change in weight and CD4+ counts from baseline to follow up were however comparable.
Conclusions: This retrospective comparative study confirmed DTG-based ART to have better efficacy and safety profiles over EFV-based ART. The outcome further justifies its adoption in the poor resource setting of sub-Saharan Africa and also provides better understanding on the potential AEs, clinically significant DDIs so as to guide the medical personnel, caregivers, counsellors and support groups in making informed clinical decisions for better treatment outcome.
