Dolutegravir in real life: Self-reported mental and physical health outcomes after transitioning from efavirenz- to dolutegravir-based antiretroviral therapy in a prospective cohort study in Lesotho.
Adult
Humans
Female
Middle Aged
Male
HIV Infections
/ drug therapy
Anti-HIV Agents
/ adverse effects
Prospective Studies
Lesotho
Self Report
Oxazines
/ therapeutic use
Benzoxazines
/ adverse effects
Lamivudine
/ therapeutic use
Heterocyclic Compounds, 3-Ring
/ adverse effects
Tenofovir
/ adverse effects
Outcome Assessment, Health Care
Africa
drug-related side effects and adverse reactions
mental health
quality of life
symptom assessment
Journal
HIV medicine
ISSN: 1468-1293
Titre abrégé: HIV Med
Pays: England
ID NLM: 100897392
Informations de publication
Date de publication:
02 2023
02 2023
Historique:
received:
18
04
2022
accepted:
31
05
2022
pubmed:
23
6
2022
medline:
16
2
2023
entrez:
22
6
2022
Statut:
ppublish
Résumé
HIV programmes across many countries in Africa have recently transitioned people living with HIV from efavirenz (EFV)- to dolutegravir (DTG)-containing antiretroviral therapy (ART). As both drugs are associated with neuropsychiatric adverse effects, this study assessed the mental health and HIV/ART-associated symptoms of people living with HIV before and after transition to DTG. The prospective DO-REAL cohort enrolled people starting DTG-based ART in Lesotho from February to December 2020. For this analysis within DO-REAL, we included adults changing from tenofovir disoproxil fumarate (TDF)/lamivudine (3TC)/EFV to TDF/3TC/DTG within first-line therapy. At transition and 16 weeks thereafter, participants completed the Patient Health Questionnaire-9 (PHQ-9; depression screening), the 12-item Short-Form Health Survey (SF-12; mental and physical health), and a modified HIV Symptom Index (mHSI; HIV/ART-related symptoms). We also assessed weight change. We used McNemar tests with Bonferroni corrections to assess binary outcomes. gov: NCT04238767. Among 1228 participants, 1131 completed follow-up. Of these, 60.0% were female, the median age was 46 years (interquartile range [IQR] 38-55), and the median time taking ART was 5.7 years (IQR 3.5-8.9). No change was observed for weight or overall PHQ-9 or SF-12 outcomes. However, three mHSI items decreased at follow-up: 'feeling sad/down/depressed' (bothered 6.0% vs. 3.3% of participants at least 'a little' before vs. after transition; adjusted p = 0.048); 'feeling nervous/anxious' (7.4% vs. 3.4%; adjusted p = 0.0009); and 'nightmares, strange/vivid dreams' (6.3% vs. 3.5%; adjusted p = 0.027). Individual PHQ-9 or SF-12 items also improved. Being symptom free across all measures increased from 5.1% to 11.4% (p < 0.0001). We observed no negative impacts and potential moderate improvements with DTG, providing further support for the rollout of DTG.
Substances chimiques
dolutegravir
DKO1W9H7M1
efavirenz
JE6H2O27P8
Anti-HIV Agents
0
Oxazines
0
Benzoxazines
0
Lamivudine
2T8Q726O95
Heterocyclic Compounds, 3-Ring
0
Tenofovir
99YXE507IL
Banques de données
ClinicalTrials.gov
['NCT04238767']
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
153-162Informations de copyright
© 2022 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.
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