New research comparing HIV medications set to change international recommendations

Date:
October 16, 2020
Source:
University of British Columbia
Summary:
A new study is set to change international treatment recommendations
for people who are newly diagnosed with HIV -- an update that
could affect nearly two million people per year worldwide.



FULL STORY ==========================================================================
A new study by UBC researchers is set to change international treatment recommendations for people who are newly diagnosed with HIV -- an update
that could affect nearly two million people per year worldwide.


==========================================================================
The study, published today by The Lancet in the journal EClinicalMedicine,
was commissioned by the World Health Organization (WHO) as part of
a planned update to its guidelines for HIV antiretroviral treatment
(ART). The study found that dolutegravir is the optimal medication for first-line treatment for people newly diagnosed with HIV, a choice that
has not been clear over the past several years.

"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," said the study's lead author,
Dr. Steve Kanters, who completed the research as a PhD candidate in UBC's School of Population and Public Health (SPPH). "In 2018, new research
warned of a potentially serious increase in risk of neural tube defects in
the children of women who became pregnant while taking this treatment."
The risk of adverse reaction meant that, although dolutegravir was found
to be favourable compared to other options, it was only recommended as
an alternative, with an antiretroviral called efavirenz recommended as
the primary treatment.

The study team, 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 (CHE'OS), and Dr. Ehsan Karim, assistant professor at SPPH, completed a network meta-analysis of research stemming from 68 available antiretroviral therapy (ART) clinical trials.

They found dolutegravir was superior to efavirenz in most outcomes,
including viral suppression, tolerability, and safety. According to
Kanters, the increased odds of viral suppression with dolutegravir
could have a significant impact on achieving international goals for
HIV treatment.



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"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," he said.

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 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.

"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," said Kanters.

"Dolutegravir appears to be here to stay as the preferred treatment for
people newly diagnosed with HIV," he said. "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." 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.

"In many places, well-treated HIV has become a chronic condition and we
are now seeing people living long lives with HIV," said Kanters. "The
research community will continue to monitor the effects dolutegravir may
have on the healthy aging process." While 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. 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.


========================================================================== Story Source: Materials provided by University_of_British_Columbia. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Steve Kanters, Marco Vitoria, Michael Zoratti, Meg Doherty, Martina
Penazzato, Ajay Rangaraj, Nathan Ford, Kristian Thorlund,
Prof. Aslam H.

Anis, Mohammad Ehsanul Karim, Lynne Mofenson, Rebecca Zash,
Alexandra Calmy, Tamara Kredo, Nick Bansback. 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. EClinicalMedicine,
2020; 100573 DOI: 10.1016/ j.eclinm.2020.100573 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/10/201016164308.htm

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