Updated assessment of risks and benefits of dolutegravir versus efavirenz in new antiretroviral treatment initiators in sub-Saharan Africa: modelling to inform treatment guidelines

Publication date: Available online 5 February 2020Source: The Lancet HIVAuthor(s): Andrew N Phillips, Loveleen Bansi-Matharu, Francois Venter, Diane Havlir, Anton Pozniak, Daniel R Kuritzkes, Annemarie Wensing, Jens D Lundgren, Deenan Pillay, John Mellors, Valentina Cambiano, Andreas Jahn, Tsitsi Apollo, Owen Mugurungi, David Ripin, Juliana Da Silva, Elliot Raizes, Nathan Ford, George K Siberry, Ravindra K GuptaSummaryBackgroundThe integrase inhibitor dolutegravir is being considered in several countries in sub-Saharan Africa instead of efavirenz for people initiating antiretroviral therapy (ART) because of superior tolerability and a lower risk of resistance emergence. WHO requested updated modelling results for its 2019 Antiretroviral Guidelines update, which was restricted to the choice of dolutegravir or efavirenz in new ART initiators. In response to this request, we modelled the risks and benefits of alternative policies for initial first-line ART regimens.MethodsWe updated an existing individual-based model of HIV transmission and progression in adults to consider information on the risk of neural tube defects in women taking dolutegravir at time of conception, as well as the effects of dolutegravir on weight gain. The model accounted for drug resistance in determining viral suppression, with consequences for clinical outcomes and mother-to-child transmission. We sampled distributions of parameters to create various epidemic setting scenarios, which reflected the diver...
Source: The Lancet HIV - Category: Infectious Diseases Source Type: research