Medical Practice Evaluation Center.
Division of Infectious Diseases, Massachusetts General Hospital.
AIDS. 2021 Dec 15;35(Suppl 2):S127-S135. doi: 10.1097/QAD.0000000000003082.
Dolutegravir (DTG) is now a component of preferred first-line antiretroviral therapy (ART) worldwide. ADVANCE and NAMSAL were two landmark clinical trials conducted exclusively in sub-Saharan Africa, which studied the effectiveness of DTG-based first-line regimens for ART-naive individuals. In this review, we examine the data from these studies to consider the contributions of adherence and HIV drug resistance to treatment failure on DTG-based ART, as compared with efavirenz (EFV)-based ART, which has a lower genetic barrier to resistance. We also discuss the implications of virologic failure on DTG and consolidate currently available data to conclude with recommendations for virologic monitoring on DTG-based ART.
多替拉韦（DTG）现已成为全球首选一线抗逆转录病毒治疗（ART）的组成部分。ADVANCE 和 NAMSAL 是两项专门在撒哈拉以南非洲进行的具有里程碑意义的临床试验，研究了 DTG 为基础的一线方案在初治人群中的有效性。在这篇综述中，我们研究了这些研究的数据，以考虑依从性和 HIV 耐药性对基于 DTG 的 ART 治疗失败的贡献，与具有较低遗传耐药屏障的依非韦伦（EFV）为基础的 ART 相比。我们还讨论了 DTG 病毒学失败的影响，并整合了目前可用的数据，得出了关于 DTG 为基础的 ART 病毒学监测的建议。
