HIV News: New Guidelines For HIV Antiretroviral Treatment (ART) Will See Dolutegravir Prescribed For Individuals Newly Diagnosed With HIV
Source: HIV News Oct 19, 2020 4 years, 1 month, 4 days, 13 hours, 24 minutes ago
HIV News: University of British Columbia researchers have concluded a new study of which the findings are set to change international treatment recommendations for individuals who are newly diagnosed with HIV, an update that could affect nearly two million people per year worldwide.
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The research found that the antiviral dolutegravir is the optimal medication for first-line treatment for individuals newly diagnosed with HIV, a choice that has not been clear over the past several years.
The research findings were published in the Lancet journal:
EClinicalMedicine,
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30317-5/fulltext
The study was commissioned by the World Health Organization (WHO) as part of a planned update to its guidelines for HIV antiretroviral treatment (ART).
Prior to this study findings, past research supporting the 2016 WHO guidelines suggested that dolutegravir was effective and well tolerated, but its efficacy and safety among key populations, such as pregnant women and people living with both HIV and tuberculosis (TB), remained unclear.
However in 2018, a study warned of a potentially serious increase in risk of neural tube defects in the children of women who became pregnant while taking this treatment."
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30326-7/fulltext#%20
Importantly the risk of adverse reaction meant that, although dolutegravir was found to be favorable compared to other options, it was only recommended as an alternative, with an antiretroviral called efavirenz recommended as the primary treatment.
The researchers which included Dr Nick Bansback, associate professor at SPPH, Dr Aslam Anis, professor at SPPH and director of the Centre for Health Evaluation and Outcome Sciences (CHÉOS), and Dr Ehsan Karim, assistant professor at SPPH, completed a network meta-analysis of research stemming from 68 available antiretroviral therapy (ART) clinical trials.
The study team found dolutegravir was superior to efavirenz in most outcomes, including viral suppression, tolerability, and safety.
According to Dr Steve Kanters, Study Lead Author and PhD Candidate, School of Population and Public Health, University of British Columbia, the increased odds of viral suppression with dolutegravir could have a significant impact on achieving international goals for HIV treatment.
Dr Kanters told Thailand Medical News, "We found about a five per cent increase in the probability of viral suppression, which means that more people who start treatment will be able to successfully control their HIV.”
Importantly another key attribute of dolutegravir is that it is effective in people who are resistant to NNRTI-class antiretrovirals, like efavirenz, a problem that is becoming increasingly common.
The detailed analysis also showed that dolutegravir and efavirenz had similar rates of adverse events for
pregnant women, the increased risk of neural tube defects for dolutegravir was estimated to be less than 0.3 per cent.
Dr Kanters added, "The new evidence on neural tube defects show that the risk with dolutegravir is much more tolerable than previously thought and should quell the initial worry about this drug.”
He added, "Dolutegravir appears to be here to stay as the preferred treatment for people newly diagnosed with HIV. However, it is important to recognize the good that efavirenz has done over the past two decades, as it helped lead the ART scale-up around the world."
However despite the many benefits of dolutegravir, dolutegravir use was associated with increased weight gain, a side effect that could increase the risk of aging-associated comorbidities, like heart attack or stroke.
Dr Kanters further added, "In many places, well-treated HIV has become a chronic condition and we are now seeing people living long lives with HIV. The research community will continue to monitor the effects dolutegravir may have on the healthy aging process."
Although this study is specifically focused on the optimal treatment for people newly diagnosed with HIV, an upcoming publication will review the evidence in support of switching to dolutegravir for people whose first treatment choice has been unsuccessful in controlling their infection.
Significantly this recommendation could mean improved treatment for the many people living with HIV around the world who are unable to achieve viral suppression despite being on treatment.
In conclusion, the evidence supports the choice of a dolutegravir in combination with tenofovir disoproxil and lamivudine (or emtricitabine) TDF+3TC/FTC as the preferred first-line regimen and Efavirenz regimens as an alternative. Dolutegravir can be considered to be an effective, safe and tolerable anchor treatment. Across a variety of outcomes, evidence strongly suggests that it is superior to efavirenz. Moreover, generic fixed-dose combinations of dolutegravir-based regimens are now available and there is greater certainty of its use in critical sub-populations resulting in greater confidence in the choice of this regimen as the preferred ARV treatment for a public health approach.
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