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Email this article Uptake and outcomes of generic dolutegravir based antiretroviral therapy in Georgia
Abstract
Background: In July 2018 the World Health Organization updated antiretroviral therapy guidelines to recommend dolutegravir (DTG) as preferred first line drug. DTG was introduced in Georgia in 2017 and since 2018 has been prescribed as preferred first line option.
Aim: We aimed to describe uptake of DTG in Georgia and evaluate outcomes of DTG-based antiretroviral therapy.
Materials and Methods: Study included all patients initiating DTG based treatment between July 1, 2017 and June 10, 2019. Data on patient demographic, epidemiological, clinical and laboratory parameters were extracted from the national AIDS health information system. Virologic response was evaluated in patients receiving DTG-based antiretroviral therapy at least for 6 months period. Viral suppression was defined as viral load (VL) <200 copies/ml. Missing VL data among patients on DTG based treatment for more than 12 months and discontinuation of therapy were defined as a failure (VL >200 copies/ml). Factors associated with achieving viral suppression were evaluated in multivariable Cox proportional hazards regression analysis.
Results: A total 635 patients initiated DTG-based therapy, among them the median age was 40 (IQR: 32-48) years, 459 (72.3%) were men, 326 (51.3%) were infected through heterosexual contact, 169 (26.6%) through injection drugs use and 123 (19.4%) through sex between men. Overall 487 (76.7%) patients received DTG as part of their first line regimen and 148 (23.3%) – as part of second line treatment. Per quarter uptake of DTG increased by 300% from 31 persons initiating DTG-based antiretroviral therapy in Jul-Sep 2017 to 124 persons in Apr-Jun 2019. Tenfovovir/emtricitabine + DTG was most commonly prescribed combination (n=510, 80.3%), followed by zidovudine/lamivudine + DTG (n=55, 8.7%), abacavir/lamivudine + DTG (n=29, 4.6%), dual-drug combination of ritonavir boosted protease inhibitor + DTG 41 (n=41, 6.5%). Of 635 patients initiating DTG-based treatment 13 patients died and 11 patients switched to other ART.. Remaining 611 patients were followed for the median 7.8 (IQR: 3.2-11.7) months. A total 369 patients were evaluable for virologic outcomes, including 363 patients remaining on DTG-based ART and 6 patients completely discontinuing ART. Among 369 patients assessed for virologic outcomes 339 (91.9%) patients had viral suppression at the last viral load measurement. Viral suppression rate was 92.9% among persons on first-line treatment and 88.8% among persons on second-line treatment. In multivariate analysis receiving first-line treatment was significantly association with achieving viral suppression (Hazard ratio: 1.58, 95% CI: 1.20-2.08, p=0.001), while time since HIV diagnosis per additional year was inversely associated with the outcome of interest (Hazard ratio: 0.92, 95% CI: 0.89-0.95, p<0.0001).
Conclusions: DTG has been successfully introduced in Georgia and the uptake has been increasing over time. Early results show effectiveness of DTG both in first- and second-line treatments. Treatment uptake, retention and viral suppression should be further monitored to inform national ART program.
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