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Clinical and Virological Outcomes of TB/HIV Coinfected Patients Treated With Dolutegravir-Based HIV Antiretroviral Regimens

Programmatic Experience From Botswana

Modongo, Chawangwa MD, MSca; Wang, Qiao MPHb; Dima, Mbatshi RNa; Matsiri, Ogopotse RNa; Kgwaadira, Botshelo MDc; Rankgoane-Pono, Goabaone MDc; Shin, Sanghyuk S. PhDb; Zetola, Nicola M. MDd

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1, 2019 - Volume 82 - Issue 2 - p 111–115
doi: 10.1097/QAI.0000000000002126
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Background: Dolutegravir (DTG) has recently been recommended as a preferred first-line regimen for the treatment of new and treatment-experienced HIV-infected patients. However, potential drug interactions between DTG and rifampicin remain a clinical and public health concern.

Methods: We analyzed HIV and Tuberculosis (TB) treatment outcomes of HIV-infected patients concomitantly receiving rifampicin- and DTG-based regimens under programmatic conditions in Botswana. The outcomes of interest were successful TB treatment and viral load suppression. We used multivariable logistic models to determine predictors for each outcome of interest.

Results: A total of 1225 patients were included in the analysis to evaluate predictors of successful TB outcome. Among patients on DTG and non-DTG regimens, 90.9% and 88.3% achieved favorable TB treatment outcomes, respectively. Of those who received DTG-based regimen; 44% received once-daily dosing and 53% twice-daily dosing. We found that DTG was associated with favorable TB treatment outcome (adjusted odds ratio = 1.56; 95% confidence interval = 1.06 to 2.31), after adjusting for age, gender, and CD4 cell counts. High rates of viral load suppression were found across all antiretroviral therapy (ART) regimen categories (>92% for all). We did not find an independent association between DTG and viral suppression after adjustment of other covariates.

Conclusions: The use of DTG-based ART regimens in patients coinfected with TB and HIV lead to favorable TB and HIV treatment outcomes, comparable to those achieved with alternative ART regimens. Our results provide reassurance to TB and HIV programs about the overall programmatic concomitant use of these first-line treatment regimens for the management of HIV and TB coinfected patients.

aBotswana-UPenn Partnership, Global Health, University of Pennsylvania, Philadelphia;

bSue and Bill Gross School of Nursing, University of California Irvine;

cPublic Health Department, Botswana National Tuberculosis Program Ministry of Health and Wellness, Gaborone, Botswana; and

dDepartment of Radiation Oncology, University of Pennsylvania Philadelphia, PA.

Correspondence to: Chawangwa Modongo, MD, MSc, Botswana-UPenn Partnership, TB program, 214 Independence avenue. P.O. Box AC157 ACH Gaborone, Botswana (e-mail: cmodongo@gmail.com).

The authors have no conflicts of interest to disclose.

C.M., N.M.Z., S.S.S., B.K., and G.R.-P. were involved in the study conception and the study design. N.M.Z. obtained the funding. C.M., N.M.Z., DM, B.K., G.R.-P., and O.M. implemented the study. S.S.S., C.M., Q.W., and N.M.Z. were involved in the analysis. C.M., S.S.S., Q.W., and N.M.Z. were involved in interpreting the data. C.M. wrote the first draft. All authors read and approved the manuscript.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaids.com).

Received January 29, 2019

Accepted May 20, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.