Supressão viral do HIV nos 12 primeiros meses de terapia antirretroviral: análise comparativa de esquemas estruturados com dolutegravir ou efavirenz, Minas Gerais 2015-2017

Detalhes bibliográficos
Autor(a) principal: Gabriella Jomara da Silva
Data de Publicação: 2020
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Repositório Institucional da UFMG
Texto Completo: http://hdl.handle.net/1843/37853
https://orcid.org/0000-0001-8836-5052
Resumo: Background: Changes in guidelines for peoples living with HIV (PLHIV) in recent years require an assessment of the first-line antiretroviral therapy (ART) effectiveness in the real-world scenario. Objective: to evaluate the viral suppression in the first year of antiretroviral treatment with dolutegravir (DTG) vs. efavirenz (EFV), and verify associated factors. Methods: This was a historical cohort study with PLHIV ≥18 years old, who started ART between 2015 and 2017 in Minas Gerais state (n=2.599). Information about age, gender, residence, viral load (VL), CD4⁺ cell count and antiretroviral dispensing were extracted from two Unified Health System databases. Viral suppression (VL <50 copies/mL) was analyzed in intention-to-treat (ITT) compared with per-protocol analysis and with VL <1.000 copies/mL. The time until the first recorded of VL <50 copies/mL was estimated by the Kaplan-Meier method. Cox proportional hazards model (HR) to determine predictors of viral suppression after six months initiating ART. Logistic regressions were used to estimate adjusted odds ratios (aORs) in the first 12 months of treatment. Statistical significance was defined a level of 5% and 95% confidence interval (95%CI). Results: Selected 2.599 individuals, 34% starting treatment with DTG and 66% with EFV. There was a predominance of men (77.5%), median age of 34 years old, baseline CD4⁺ 322 cell/mmᵌ and VL 4.7 (log) copies/mL. The changes in the ART occurred in 5% of PLHIV that began with DTG and 9.2% with EFV-based regimens (p<.0001). In ITT, higher proportion of viral suppression was observed for DTG compared to EFV (76.7% vs. 58.1%), even considering VL <1.000 copies (p<0.0001). DTG-based regime had less time until the first recorded of VL <50 copies/mL after six months initiating ART (HR=1.29; 95%CI 1.15 – 1.43) and higher odds in the first 12 months (aORs=2.44; 95%CI 2.01 – 2.95). ART initiation <120 days, CD4⁺ T-cell count ≥200 cell/μl and baseline VL <100,000 copies/mL also had higher odds of viral suppression. In protocol analysis was observed largest proportion of viral suppression and ART groups had the same time interval until the outcome. Conclusion: After the introduction of DTG, the viral suppression results were improved, though observed proportions was lower than the expected according to the third global target.
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spelling Supressão viral do HIV nos 12 primeiros meses de terapia antirretroviral: análise comparativa de esquemas estruturados com dolutegravir ou efavirenz, Minas Gerais 2015-2017HIV-1AntirretroviraisEfetividadeCarga ViralHIV-1AntirretroviraisEfetividadeCarga ViralEstudos de CoortesBackground: Changes in guidelines for peoples living with HIV (PLHIV) in recent years require an assessment of the first-line antiretroviral therapy (ART) effectiveness in the real-world scenario. Objective: to evaluate the viral suppression in the first year of antiretroviral treatment with dolutegravir (DTG) vs. efavirenz (EFV), and verify associated factors. Methods: This was a historical cohort study with PLHIV ≥18 years old, who started ART between 2015 and 2017 in Minas Gerais state (n=2.599). Information about age, gender, residence, viral load (VL), CD4⁺ cell count and antiretroviral dispensing were extracted from two Unified Health System databases. Viral suppression (VL <50 copies/mL) was analyzed in intention-to-treat (ITT) compared with per-protocol analysis and with VL <1.000 copies/mL. The time until the first recorded of VL <50 copies/mL was estimated by the Kaplan-Meier method. Cox proportional hazards model (HR) to determine predictors of viral suppression after six months initiating ART. Logistic regressions were used to estimate adjusted odds ratios (aORs) in the first 12 months of treatment. Statistical significance was defined a level of 5% and 95% confidence interval (95%CI). Results: Selected 2.599 individuals, 34% starting treatment with DTG and 66% with EFV. There was a predominance of men (77.5%), median age of 34 years old, baseline CD4⁺ 322 cell/mmᵌ and VL 4.7 (log) copies/mL. The changes in the ART occurred in 5% of PLHIV that began with DTG and 9.2% with EFV-based regimens (p<.0001). In ITT, higher proportion of viral suppression was observed for DTG compared to EFV (76.7% vs. 58.1%), even considering VL <1.000 copies (p<0.0001). DTG-based regime had less time until the first recorded of VL <50 copies/mL after six months initiating ART (HR=1.29; 95%CI 1.15 – 1.43) and higher odds in the first 12 months (aORs=2.44; 95%CI 2.01 – 2.95). ART initiation <120 days, CD4⁺ T-cell count ≥200 cell/μl and baseline VL <100,000 copies/mL also had higher odds of viral suppression. In protocol analysis was observed largest proportion of viral suppression and ART groups had the same time interval until the outcome. Conclusion: After the introduction of DTG, the viral suppression results were improved, though observed proportions was lower than the expected according to the third global target.Introdução: Recentes mudanças no guia terapêutico em pessoas vivendo com o HIV (PVHIV) requer a avaliação da efetividade da terapia antirretroviral (TARV) utilizada na primeira linha de tratamento no cenário do mundo real. Objetivo: Avaliar a supressão viral em até 12 meses do início do tratamento com dolutegravir (DTG) vs. efavirenz (EFV), e verificar os fatores associados. Metodologia: Coorte histórica de PVHIV, ≥18 anos, que iniciaram a TARV entre 2015 e 2017 em Minas Gerais. Informações sobre idade, sexo, residência, carga viral (CV), linfócitos T CD4+ (LT-CD4+) e dispensação da TARV foram extraídas de duas bases de dados do Sistema Único de Saúde. A supressão viral (CV <50 cópias/mL) foi analisada em intenção de tratar (ITT) comparados com a análise conforme protocolo e com CV <1.000 cópias/mL. O tempo até o primeiro registro de CV <50 cópias/mL foi estimado pelo método de Kaplan-Meier. Modelo de riscos proporcionais de Cox para determinar os preditores para supressão viral nos seis primeiros meses. Regressão Logística foi utilizada para estimativa do Odds Ratio Ajustado (ORa) em até 12 meses. Considerou-se o nível de significância de 5% e o intervalo de confiança de 95% (IC95%). Resultados: Selecionado 2.599 indivíduos, 34% iniciaram tratamento com DTG e 66% com EFV. A maioria era do sexo masculino (77,5%), com mediana de idade 34 anos, exames basais de LT-CD4+ 322 céls/mmᵌ e CV 4,7 (log) cópias/mL. As trocas ocorreram em 5% das PVHIV que iniciaram com esquemas estruturados com DTG e 9,2% com EFV (p<0,0001). Em ITT, maior proporção de supressão viral foi observada para DTG comparado ao EFV (76,7% vs. 58,1%), mesmo quando considerado CV <1.000 cópias/mL (p<0,0001). Esquemas com DTG apresentaram menor tempo para o primeiro registro de CV <50 cópias/mL em seis meses (HR=1,29; IC95% 1,15 – 1,43) e maior chance de supressão viral em 12 meses (ORa=2,44; IC95% 2,01 – 2,95). Outras variáveis associadas ao desfecho foram tempo de início da TARV <120 dias, LT-CD4+ ≥200 céls/mmᵌ e CV basal <100.000 cópias/mL. Em análise conforme o protocolo foi observado maiores proporções de supressão viral e o mesmo intervalo de tempo até o desfecho em ambos os grupos da TARV. Conclusão: Após a introdução do DTG, houve melhorias dos resultados de supressão viral, embora as proporções observadas estejam abaixo da expectativa da terceira meta global.Universidade Federal de Minas GeraisBrasilMEDICINA - FACULDADE DE MEDICINAPrograma de Pós-Graduação em Ciências da Saúde - Infectologia e Medicina TropicalUFMGUnaí Tupinambáshttp://lattes.cnpq.br/9944131333164201Cristiane Aparecida Menezes de Páduahttp://lattes.cnpq.br/0999148325656924Helena DuaniGustavo Machado RochaGabriella Jomara da Silva2021-08-31T15:56:02Z2021-08-31T15:56:02Z2020-02-14info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisapplication/pdfhttp://hdl.handle.net/1843/37853https://orcid.org/0000-0001-8836-5052porinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMG2021-08-31T15:56:03Zoai:repositorio.ufmg.br:1843/37853Repositório InstitucionalPUBhttps://repositorio.ufmg.br/oairepositorio@ufmg.bropendoar:2021-08-31T15:56:03Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
dc.title.none.fl_str_mv Supressão viral do HIV nos 12 primeiros meses de terapia antirretroviral: análise comparativa de esquemas estruturados com dolutegravir ou efavirenz, Minas Gerais 2015-2017
title Supressão viral do HIV nos 12 primeiros meses de terapia antirretroviral: análise comparativa de esquemas estruturados com dolutegravir ou efavirenz, Minas Gerais 2015-2017
spellingShingle Supressão viral do HIV nos 12 primeiros meses de terapia antirretroviral: análise comparativa de esquemas estruturados com dolutegravir ou efavirenz, Minas Gerais 2015-2017
Gabriella Jomara da Silva
HIV-1
Antirretrovirais
Efetividade
Carga Viral
HIV-1
Antirretrovirais
Efetividade
Carga Viral
Estudos de Coortes
title_short Supressão viral do HIV nos 12 primeiros meses de terapia antirretroviral: análise comparativa de esquemas estruturados com dolutegravir ou efavirenz, Minas Gerais 2015-2017
title_full Supressão viral do HIV nos 12 primeiros meses de terapia antirretroviral: análise comparativa de esquemas estruturados com dolutegravir ou efavirenz, Minas Gerais 2015-2017
title_fullStr Supressão viral do HIV nos 12 primeiros meses de terapia antirretroviral: análise comparativa de esquemas estruturados com dolutegravir ou efavirenz, Minas Gerais 2015-2017
title_full_unstemmed Supressão viral do HIV nos 12 primeiros meses de terapia antirretroviral: análise comparativa de esquemas estruturados com dolutegravir ou efavirenz, Minas Gerais 2015-2017
title_sort Supressão viral do HIV nos 12 primeiros meses de terapia antirretroviral: análise comparativa de esquemas estruturados com dolutegravir ou efavirenz, Minas Gerais 2015-2017
author Gabriella Jomara da Silva
author_facet Gabriella Jomara da Silva
author_role author
dc.contributor.none.fl_str_mv Unaí Tupinambás
http://lattes.cnpq.br/9944131333164201
Cristiane Aparecida Menezes de Pádua
http://lattes.cnpq.br/0999148325656924
Helena Duani
Gustavo Machado Rocha
dc.contributor.author.fl_str_mv Gabriella Jomara da Silva
dc.subject.por.fl_str_mv HIV-1
Antirretrovirais
Efetividade
Carga Viral
HIV-1
Antirretrovirais
Efetividade
Carga Viral
Estudos de Coortes
topic HIV-1
Antirretrovirais
Efetividade
Carga Viral
HIV-1
Antirretrovirais
Efetividade
Carga Viral
Estudos de Coortes
description Background: Changes in guidelines for peoples living with HIV (PLHIV) in recent years require an assessment of the first-line antiretroviral therapy (ART) effectiveness in the real-world scenario. Objective: to evaluate the viral suppression in the first year of antiretroviral treatment with dolutegravir (DTG) vs. efavirenz (EFV), and verify associated factors. Methods: This was a historical cohort study with PLHIV ≥18 years old, who started ART between 2015 and 2017 in Minas Gerais state (n=2.599). Information about age, gender, residence, viral load (VL), CD4⁺ cell count and antiretroviral dispensing were extracted from two Unified Health System databases. Viral suppression (VL <50 copies/mL) was analyzed in intention-to-treat (ITT) compared with per-protocol analysis and with VL <1.000 copies/mL. The time until the first recorded of VL <50 copies/mL was estimated by the Kaplan-Meier method. Cox proportional hazards model (HR) to determine predictors of viral suppression after six months initiating ART. Logistic regressions were used to estimate adjusted odds ratios (aORs) in the first 12 months of treatment. Statistical significance was defined a level of 5% and 95% confidence interval (95%CI). Results: Selected 2.599 individuals, 34% starting treatment with DTG and 66% with EFV. There was a predominance of men (77.5%), median age of 34 years old, baseline CD4⁺ 322 cell/mmᵌ and VL 4.7 (log) copies/mL. The changes in the ART occurred in 5% of PLHIV that began with DTG and 9.2% with EFV-based regimens (p<.0001). In ITT, higher proportion of viral suppression was observed for DTG compared to EFV (76.7% vs. 58.1%), even considering VL <1.000 copies (p<0.0001). DTG-based regime had less time until the first recorded of VL <50 copies/mL after six months initiating ART (HR=1.29; 95%CI 1.15 – 1.43) and higher odds in the first 12 months (aORs=2.44; 95%CI 2.01 – 2.95). ART initiation <120 days, CD4⁺ T-cell count ≥200 cell/μl and baseline VL <100,000 copies/mL also had higher odds of viral suppression. In protocol analysis was observed largest proportion of viral suppression and ART groups had the same time interval until the outcome. Conclusion: After the introduction of DTG, the viral suppression results were improved, though observed proportions was lower than the expected according to the third global target.
publishDate 2020
dc.date.none.fl_str_mv 2020-02-14
2021-08-31T15:56:02Z
2021-08-31T15:56:02Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
format masterThesis
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/1843/37853
https://orcid.org/0000-0001-8836-5052
url http://hdl.handle.net/1843/37853
https://orcid.org/0000-0001-8836-5052
dc.language.iso.fl_str_mv por
language por
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Universidade Federal de Minas Gerais
Brasil
MEDICINA - FACULDADE DE MEDICINA
Programa de Pós-Graduação em Ciências da Saúde - Infectologia e Medicina Tropical
UFMG
publisher.none.fl_str_mv Universidade Federal de Minas Gerais
Brasil
MEDICINA - FACULDADE DE MEDICINA
Programa de Pós-Graduação em Ciências da Saúde - Infectologia e Medicina Tropical
UFMG
dc.source.none.fl_str_mv reponame:Repositório Institucional da UFMG
instname:Universidade Federal de Minas Gerais (UFMG)
instacron:UFMG
instname_str Universidade Federal de Minas Gerais (UFMG)
instacron_str UFMG
institution UFMG
reponame_str Repositório Institucional da UFMG
collection Repositório Institucional da UFMG
repository.name.fl_str_mv Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)
repository.mail.fl_str_mv repositorio@ufmg.br
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