Dolutegravir versus efavirenz; A comparison of theeffectiveness of two antiretroviral regimens in the treatment of HIVpatients

Background and Aim : HIV infection is still a public health threat, infecting over ۳۷ millionindividuals worldwide. Prior to ۲۰۱۸, WHO guidelines regarding the recommended first-lineantiretroviral therapy (ART) for HIV treatment comprised two nucleoside reverse-transcriptaseinhibitors (NRTIs) in combination with a nonnucleoside reverse-transcriptase inhibitor (NNRTI)called efavirenz. Then, based on novel studies, dolutegravir, which seemed to have a moredesirable profile than efavirenz, replaced this medication in the recommended first-line ART.Given that constant evaluation of the effectiveness of the first-line ART regimen is vital inachieving virological and immunological success in the treatment of HIV, we aimed to evaluatethe effectiveness of two regimens; one consisting of tenofovir, emtricitabine, and efavirenz, andthe other consisting of tenofovir, emtricitabine, and dolutegravir in providing the optimalvirological suppression and immunological recovery.Methods : This retrospective study evaluated HIV-positive patients who had been referred to theconsultation centers for behavioral and infectious diseases in Mashhad, Iran, from March ۲۰۱۷until March ۲۰۲۱. ۴۳ patients who had been infected via drug injection and ۸۷ who had beeninfected through sexual contact were selected, and CD۴ count and viral load were assessedperiodically.Results : Among the ۴۳ patients who had been infected with HIV via drug injection, ۷ patients(۱۵%) had immunological failure, and ۳ patients (۶.۹%) had virological failure, according to Iran’snational guidelines for HIV/AIDS care and treatment. Among the ۸۷ subjects who had beeninfected with HIV via sexual contact, ۳ patients (۳.۴%) were in the category of immunologicalfailure, and ۵ patients (۵.۷%) were in the category of virological failure.Conclusion : Most cases of virological and immunological failure, as well as cases of nonadherenceto treatment, were observed in patients that received the regimen containing efavirenz.In contrast, the rate of CD۴ growth was higher in patients receiving the regimen that includeddolutegravir, and fewer side effects and treatment failures were seen in this group. Furthermore,the latter regimen seems to have more economic viability for the healthcare system of the country.Therefore, the use of a combination of tenofovir, emtricitabine, and dolutegravir is recommendedas the first line of ART for HIV patients.

Keywords:

HIV , Antiretroviral Therapy , ART Regimens , Dolutegravir , Efavirenz