Viral Load Status Before Switching to Dolutegravir-Containing Antiretroviral Therapy and Associations With Human Immunodeficiency Virus Treatment Outcomes in Sub-Saharan Africa
Dolutegravir is being rolled out globally as part of preferred antiretroviral therapy (ART) regimens, including among treatment-experienced patients. The role of viral load (VL) testing before switching patients already on ART to a dolutegravir-containing regimen is less clear in real-world settings...
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| Veröffentlicht in: | Clinical infectious diseases 2022-09, Vol.75 (4), p.630-637 |
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| creator | Romo, Matthew L Edwards, Jessie K Semeere, Aggrey S Musick, Beverly S Urassa, Mark Odhiambo, Francesca Diero, Lameck Kasozi, Charles Murenzi, Gad Lelo, Patricia Wyka, Katarzyna Kelvin, Elizabeth A Sohn, Annette H Wools-Kaloustian, Kara K Nash, Denis |
| description | Dolutegravir is being rolled out globally as part of preferred antiretroviral therapy (ART) regimens, including among treatment-experienced patients. The role of viral load (VL) testing before switching patients already on ART to a dolutegravir-containing regimen is less clear in real-world settings.
We included patients from the International epidemiology Databases to Evaluate AIDS consortium who switched from a nevirapine- or efavirenz-containing regimen to one with dolutegravir. We used multivariable cause-specific hazards regression to estimate the association of the most recent VL test in the 12 months before switching with subsequent outcomes.
We included 36 393 patients at 37 sites in 5 countries (Democratic Republic of the Congo, Kenya, Rwanda, Tanzania, Uganda) who switched to dolutegravir from July 2017 through February 2020, with a median follow-up of approximately 11 months. Compared with those who switched with a VL |
| doi_str_mv | 10.1093/cid/ciab1006 |
| format | Article |
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We included patients from the International epidemiology Databases to Evaluate AIDS consortium who switched from a nevirapine- or efavirenz-containing regimen to one with dolutegravir. We used multivariable cause-specific hazards regression to estimate the association of the most recent VL test in the 12 months before switching with subsequent outcomes.
We included 36 393 patients at 37 sites in 5 countries (Democratic Republic of the Congo, Kenya, Rwanda, Tanzania, Uganda) who switched to dolutegravir from July 2017 through February 2020, with a median follow-up of approximately 11 months. Compared with those who switched with a VL <200 copies/mL, patients without a recent VL test or with a preswitch VL ≥1000 copies/mL had significantly increased hazards of an incident VL ≥1000 copies/mL (adjusted hazard ratio [aHR], 2.89; 95% confidence interval [CI], 1.99-4.19 and aHR, 6.60; 95% CI, 4.36-9.99, respectively) and pulmonary tuberculosis or a World Health Organization clinical stage 4 event (aHR, 4.78; 95% CI, 2.77-8.24 and aHR, 13.97; 95% CI, 6.62-29.50, respectively).
A VL test before switching to dolutegravir may help identify patients who need additional clinical monitoring and/or adherence support. Further surveillance of patients who switched to dolutegravir with an unknown or unsuppressed VL is needed.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciab1006</identifier><identifier>PMID: 34893813</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Anti-HIV Agents - therapeutic use ; Heterocyclic Compounds, 3-Ring ; HIV ; HIV Infections - epidemiology ; Humans ; Kenya ; Major ; Oxazines ; Piperazines ; Pyridones ; Treatment Outcome ; Viral Load</subject><ispartof>Clinical infectious diseases, 2022-09, Vol.75 (4), p.630-637</ispartof><rights>The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.</rights><rights>The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-559df7c317db9be63c429f99c0594144d356ab0118f8367f79a598130de082043</citedby><cites>FETCH-LOGICAL-c384t-559df7c317db9be63c429f99c0594144d356ab0118f8367f79a598130de082043</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,882,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34893813$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Romo, Matthew L</creatorcontrib><creatorcontrib>Edwards, Jessie K</creatorcontrib><creatorcontrib>Semeere, Aggrey S</creatorcontrib><creatorcontrib>Musick, Beverly S</creatorcontrib><creatorcontrib>Urassa, Mark</creatorcontrib><creatorcontrib>Odhiambo, Francesca</creatorcontrib><creatorcontrib>Diero, Lameck</creatorcontrib><creatorcontrib>Kasozi, Charles</creatorcontrib><creatorcontrib>Murenzi, Gad</creatorcontrib><creatorcontrib>Lelo, Patricia</creatorcontrib><creatorcontrib>Wyka, Katarzyna</creatorcontrib><creatorcontrib>Kelvin, Elizabeth A</creatorcontrib><creatorcontrib>Sohn, Annette H</creatorcontrib><creatorcontrib>Wools-Kaloustian, Kara K</creatorcontrib><creatorcontrib>Nash, Denis</creatorcontrib><creatorcontrib>International epidemiology Databases to Evaluate AIDS (IeDEA)</creatorcontrib><title>Viral Load Status Before Switching to Dolutegravir-Containing Antiretroviral Therapy and Associations With Human Immunodeficiency Virus Treatment Outcomes in Sub-Saharan Africa</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Dolutegravir is being rolled out globally as part of preferred antiretroviral therapy (ART) regimens, including among treatment-experienced patients. The role of viral load (VL) testing before switching patients already on ART to a dolutegravir-containing regimen is less clear in real-world settings.
We included patients from the International epidemiology Databases to Evaluate AIDS consortium who switched from a nevirapine- or efavirenz-containing regimen to one with dolutegravir. We used multivariable cause-specific hazards regression to estimate the association of the most recent VL test in the 12 months before switching with subsequent outcomes.
We included 36 393 patients at 37 sites in 5 countries (Democratic Republic of the Congo, Kenya, Rwanda, Tanzania, Uganda) who switched to dolutegravir from July 2017 through February 2020, with a median follow-up of approximately 11 months. Compared with those who switched with a VL <200 copies/mL, patients without a recent VL test or with a preswitch VL ≥1000 copies/mL had significantly increased hazards of an incident VL ≥1000 copies/mL (adjusted hazard ratio [aHR], 2.89; 95% confidence interval [CI], 1.99-4.19 and aHR, 6.60; 95% CI, 4.36-9.99, respectively) and pulmonary tuberculosis or a World Health Organization clinical stage 4 event (aHR, 4.78; 95% CI, 2.77-8.24 and aHR, 13.97; 95% CI, 6.62-29.50, respectively).
A VL test before switching to dolutegravir may help identify patients who need additional clinical monitoring and/or adherence support. Further surveillance of patients who switched to dolutegravir with an unknown or unsuppressed VL is needed.</description><subject>Anti-HIV Agents - therapeutic use</subject><subject>Heterocyclic Compounds, 3-Ring</subject><subject>HIV</subject><subject>HIV Infections - epidemiology</subject><subject>Humans</subject><subject>Kenya</subject><subject>Major</subject><subject>Oxazines</subject><subject>Piperazines</subject><subject>Pyridones</subject><subject>Treatment Outcome</subject><subject>Viral Load</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUU2P0zAQjRCIXRZunJGPHAjYtZPYF6RSFnalSntogaM1sZ3GKLGLP4r6r_Yn4rIfgsNoRpo3b97Mq6rXBL8nWNAPyuoS0BOM2yfVOWloV7eNIE9LjRteM075WfUixp8YE8Jx87w6o4wLygk9r26_2wATWnvQaJMg5Yg-mcEHgza_bVKjdTuUPPrsp5zMLsDBhnrlXQLrTq2lSzaYFPzhL812NAH2RwROo2WMvuhK1ruIftg0oqs8g0PX85yd12awyhqnjqgoKFu3wUCajUvoJiflZxORdWiT-3oDI4QyuByCVfCyejbAFM2r-3xRfftyuV1d1eubr9er5bpWlLNUN43QQ6co6XQvetNSxRZiEELhRjDCmKZNC_3pIQOnbTd0AhpRPoK1wXyBGb2oPt7x7nM_G62KsnKh3Ac7QzhKD1b-33F2lDt_kIK1DHdtIXh7TxD8r2xikrONykwTOONzlIt2QXHHuRAF-u4OqoKPMZjhcQ3B8mSyLCbLB5ML_M2_0h7BD67SP64fqJY</recordid><startdate>20220910</startdate><enddate>20220910</enddate><creator>Romo, Matthew L</creator><creator>Edwards, Jessie K</creator><creator>Semeere, Aggrey S</creator><creator>Musick, Beverly S</creator><creator>Urassa, Mark</creator><creator>Odhiambo, Francesca</creator><creator>Diero, Lameck</creator><creator>Kasozi, Charles</creator><creator>Murenzi, Gad</creator><creator>Lelo, Patricia</creator><creator>Wyka, Katarzyna</creator><creator>Kelvin, Elizabeth A</creator><creator>Sohn, Annette H</creator><creator>Wools-Kaloustian, Kara K</creator><creator>Nash, Denis</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20220910</creationdate><title>Viral Load Status Before Switching to Dolutegravir-Containing Antiretroviral Therapy and Associations With Human Immunodeficiency Virus Treatment Outcomes in Sub-Saharan Africa</title><author>Romo, Matthew L ; Edwards, Jessie K ; Semeere, Aggrey S ; Musick, Beverly S ; Urassa, Mark ; Odhiambo, Francesca ; Diero, Lameck ; Kasozi, Charles ; Murenzi, Gad ; Lelo, Patricia ; Wyka, Katarzyna ; Kelvin, Elizabeth A ; Sohn, Annette H ; Wools-Kaloustian, Kara K ; Nash, Denis</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-559df7c317db9be63c429f99c0594144d356ab0118f8367f79a598130de082043</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Anti-HIV Agents - therapeutic use</topic><topic>Heterocyclic Compounds, 3-Ring</topic><topic>HIV</topic><topic>HIV Infections - epidemiology</topic><topic>Humans</topic><topic>Kenya</topic><topic>Major</topic><topic>Oxazines</topic><topic>Piperazines</topic><topic>Pyridones</topic><topic>Treatment Outcome</topic><topic>Viral Load</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Romo, Matthew L</creatorcontrib><creatorcontrib>Edwards, Jessie K</creatorcontrib><creatorcontrib>Semeere, Aggrey S</creatorcontrib><creatorcontrib>Musick, Beverly S</creatorcontrib><creatorcontrib>Urassa, Mark</creatorcontrib><creatorcontrib>Odhiambo, Francesca</creatorcontrib><creatorcontrib>Diero, Lameck</creatorcontrib><creatorcontrib>Kasozi, Charles</creatorcontrib><creatorcontrib>Murenzi, Gad</creatorcontrib><creatorcontrib>Lelo, Patricia</creatorcontrib><creatorcontrib>Wyka, Katarzyna</creatorcontrib><creatorcontrib>Kelvin, Elizabeth A</creatorcontrib><creatorcontrib>Sohn, Annette H</creatorcontrib><creatorcontrib>Wools-Kaloustian, Kara K</creatorcontrib><creatorcontrib>Nash, Denis</creatorcontrib><creatorcontrib>International epidemiology Databases to Evaluate AIDS (IeDEA)</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Romo, Matthew L</au><au>Edwards, Jessie K</au><au>Semeere, Aggrey S</au><au>Musick, Beverly S</au><au>Urassa, Mark</au><au>Odhiambo, Francesca</au><au>Diero, Lameck</au><au>Kasozi, Charles</au><au>Murenzi, Gad</au><au>Lelo, Patricia</au><au>Wyka, Katarzyna</au><au>Kelvin, Elizabeth A</au><au>Sohn, Annette H</au><au>Wools-Kaloustian, Kara K</au><au>Nash, Denis</au><aucorp>International epidemiology Databases to Evaluate AIDS (IeDEA)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Viral Load Status Before Switching to Dolutegravir-Containing Antiretroviral Therapy and Associations With Human Immunodeficiency Virus Treatment Outcomes in Sub-Saharan Africa</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2022-09-10</date><risdate>2022</risdate><volume>75</volume><issue>4</issue><spage>630</spage><epage>637</epage><pages>630-637</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Dolutegravir is being rolled out globally as part of preferred antiretroviral therapy (ART) regimens, including among treatment-experienced patients. The role of viral load (VL) testing before switching patients already on ART to a dolutegravir-containing regimen is less clear in real-world settings.
We included patients from the International epidemiology Databases to Evaluate AIDS consortium who switched from a nevirapine- or efavirenz-containing regimen to one with dolutegravir. We used multivariable cause-specific hazards regression to estimate the association of the most recent VL test in the 12 months before switching with subsequent outcomes.
We included 36 393 patients at 37 sites in 5 countries (Democratic Republic of the Congo, Kenya, Rwanda, Tanzania, Uganda) who switched to dolutegravir from July 2017 through February 2020, with a median follow-up of approximately 11 months. Compared with those who switched with a VL <200 copies/mL, patients without a recent VL test or with a preswitch VL ≥1000 copies/mL had significantly increased hazards of an incident VL ≥1000 copies/mL (adjusted hazard ratio [aHR], 2.89; 95% confidence interval [CI], 1.99-4.19 and aHR, 6.60; 95% CI, 4.36-9.99, respectively) and pulmonary tuberculosis or a World Health Organization clinical stage 4 event (aHR, 4.78; 95% CI, 2.77-8.24 and aHR, 13.97; 95% CI, 6.62-29.50, respectively).
A VL test before switching to dolutegravir may help identify patients who need additional clinical monitoring and/or adherence support. Further surveillance of patients who switched to dolutegravir with an unknown or unsuppressed VL is needed.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>34893813</pmid><doi>10.1093/cid/ciab1006</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Anti-HIV Agents - therapeutic use Heterocyclic Compounds, 3-Ring HIV HIV Infections - epidemiology Humans Kenya Major Oxazines Piperazines Pyridones Treatment Outcome Viral Load |
| title | Viral Load Status Before Switching to Dolutegravir-Containing Antiretroviral Therapy and Associations With Human Immunodeficiency Virus Treatment Outcomes in Sub-Saharan Africa |
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