Dolutegravir versus efavirenz-based regimen treatment outcome and its predictors at Jimma medical center, ART clinic, southwest Ethiopia. Comparative, retrospective observational study

Abstract

Introduction: Comparison studies show that the efavirenz-based first line was associated with less rate of virologic suppression and more drug-related adverse events which leads to frequent discontinuation when compared to the dolutegravir-based regime. Due to these, dolutegravir, the second-generation integrase strand transfer inhibitor, was recommended by the world health organization to be part of antiretroviral treatment in 2018. However, most of the evidence comes from a clinical trial with restricted patients exposure. Objective: To compare treatment outcomes and its predictors among patients who were on efavirenz-based first-line and shifted to dolutegravir-based first-line. Methods: A retrospective observational study was conducted from September 1, 2017, to August 31, 2021, among three hundred fifty-six participants at Jimma medical center ART clinic. The primary outcome was virologic suppression and immunological response. SPSS version 26 software was used for data analysis. Binary logistic regression between independent variables and treatment outcome was done. The variables with p-value <0.25 were entered into a multivariate logistic regression model to determine the independent predictors of treatment outcome and variables with p-value <0.05 were considered statistically significant. Results: The mean age of the participants was 40.61 ± 9.2 years and 212 (59.6%) were female. Virologic suppression was achieved in 89.6% of participants on dolutegravir and 78.9% on an efavirenz-based regimen. Independent predictors of virologic suppression were good adherence (AOR=9.22, 95% CI: 3.70- 22.92, p<0.001), secondary/tertiary educational level (AOR=6.20,95% CI: 2.15-17.61, p-0.001) and having no opportunistic infections (AOR=4.23,95% CI: 1.83-9.78, p- 0.001). In another case 172 (72.3%) participants have a CD4 cell count greater than 350 cells/mm3 on TLE while 202 (84.9%) participants have a CD4 count greater than 350 cells/mm3 on DTG. Female ( AOR= 2.83, 95%CI: 1.30- 6.20, p-0.009 ) and isoniazid preventive therapy use (AOR= 2.82, 95%CI: 1.06-7.50, p-0.038) were independent predictors of immunologic response. Conclusion and recommendation: This study identified that DTG based regimen maintains virologic suppression and increases immunologic response. Adherence, educational level, and having no opportunistic infection were significantly associated with viral suppression. Female and isoniazid preventive therapy use were independent predictors of immunologic response. Continuous monitoring of long-term virological and immunological outcomes of DTG-based regimens among HIV/AIDs patients is also essential to observe the consistency of DTG-based favorable outcome