Forskning
Udskriv Udskriv
Switch language
Region Hovedstaden - en del af Københavns Universitetshospital
Udgivet

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

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  1. Is HIV a provoking factor for venous thrombotic events?

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. How do we preserve health among adults living with HIV?

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. Risks and benefits of dolutegravir-based antiretroviral drug regimens in sub-Saharan Africa: a modelling study

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  4. Cardiovascular disease and use of contemporary protease inhibitors: the D:A:D international prospective multicohort study

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  5. Language used to convey HIV infection risk is important - Authors' reply

    Publikation: Bidrag til tidsskriftKommentar/debatForskningpeer review

  1. Mortality and admission to intensive care units after febrile neutropenia in patients with cancer

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. Uptake and Discontinuation of Integrase Inhibitors (INSTIs) in a Large Cohort Setting

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. The EuroSIDA study: 25 years of scientific achievements

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  • 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 Gupta
  • Ruanne Barnabas
  • Paul Revill
  • Jennifer Cohn
  • Alexandra Calmy
  • Silvia Bertagnolio
Vis graf over relationer

BACKGROUND: The 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.

METHODS: We 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 diversity of epidemic and programmatic situations in sub-Saharan Africa. For each setting scenario, we considered the situation in 2018 and compared ART initiation policies of an efavirenz-based regimen in women intending pregnancy, and a dolutegravir-based regimen in others, and a dolutegravir-based regimen, including in women intending pregnancy. We considered predicted outcomes over a 20-year period from 2019 to 2039, used a 3% discount rate, and a cost-effectiveness threshold of US$500 per disability-adjusted life-year (DALY) averted.

FINDINGS: Considering updated information on risks and benefits, a policy of ART initiation with a dolutegravir-based regimen rather than an efavirenz-based regimen, including in women intending pregnancy, is predicted to bring population health benefits (10 990 DALYs averted per year) and to be cost-saving (by $2·9 million per year), leading to a reduction in the overall population burden of disease of 16 735 net DALYs per year for a country with an adult population size of 10 million. The policy involving ART initiation with a dolutegravir-based regimen in women intending pregnancy was cost-effective in 87% of our setting scenarios and this finding was robust in various sensitivity analyses, including around the potential negative effects of weight gain.

INTERPRETATION: In the context of a range of modelled setting scenarios in sub-Saharan Africa, we found that a policy of ART initiation with a dolutegravir-based regimen, including in women intending pregnancy, was predicted to bring population health benefits and be cost-effective, supporting WHO's strong recommendation for dolutegravir as a preferred drug for ART initiators.

FUNDING: Bill & Melinda Gates Foundation.

OriginalsprogEngelsk
TidsskriftThe Lancet HIV
Vol/bind7
Udgave nummer3
Sider (fra-til)e193-e200
ISSN2352-3018
DOI
StatusUdgivet - mar. 2020

Bibliografisk note

Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

ID: 59339634