At the University of British Columbia, a new study published today in the Clinical Medicine, revealed new observations that are set to change the international recommendations for the treatment of HIV that is newly diagnosed in patients. Investigators maintain that this new update has the potential to affect nearly two million people annually worldwide.
NEW Research: Comparative efficacy, tolerability and safety of #dolutegravir and #efavirenz 400mg among antiretroviral therapies for first-line #HIV treatment: A systematic literature review and network meta-analysis#openaccess https://t.co/8bcJ4zSoSt pic.twitter.com/4KRE6R0VPX
— EClinicalMedicine – Published by The Lancet (@EClinicalMed) October 16, 2020
WHO commissioned the study and started it as a part of the planned update to its guidelines for HIV antiretroviral treatment ART. In 2016, WHO ART consolidated guidelines on the use of antiretrovirals for the treatment and prevention of the HIV included a strong recommendation for the “combination of efavirenz, tenofovir disoproxil and lamivudine (or emtricitabine) [EFV+TDF+3TC/FTC] as the preferred first-line ART regimen”.
Evidences indicate that the dolutegravir (DTG) has favorable efficacy, safety, and tolerability, relative to EFV and improved tolerability with low-dose efavirenz. However, data is lacking in evidences on use of dolutegravir during pregnancy.
In the current, intention was to update the recommendation and guidelines to intervene new treatment. Study reviewed over 156 publications that was constituted up to 68 trails for the primary population. It was found that the dolutegravir is believed the optimal therapeutic option as a first line treatment for people newly diagnosed with HIV, a choice that has not been clear over the past several years.
Furthermore, relative to efavirenz, it is speculated that the dolutegravir had improved capacity to suppress the viral count, more protective against the drug-resistance, and led to fewer discontinuations. Moreover, dolutegravir use was effective among persons co-infected with hepatitis and HIV, and in pregnant women.
However, in pregnancies that were managed by the dolutegravir, adverse birth outcomes were observed in 33.2% of the cases and in case of efavirenz-managed pregnancies, 35% birth defects were observed.
Therefore, it is interpreted from the study that the risk of adverse reaction implicates, relative to the primary treatment called efavirenz, dolutegravir was found to be favorable, hence recommended as an alternative.
According to Dr. Steve Kanters, who completed the research as a PhD candidate in UBC’s School of Population and Public Health (SPPH)., “The increased odds of viral suppression with dolutegravir could have a significant impact on achieving international goals for HIV treatment.”
Despite the efficacy and the evidences of benefits of dolutegravir, its uses were linked to increased weight gain, it could increase the risk of aging-associated comorbidities, like heart attack and stroke.