Evaluation of antiretroviral regimen switching options in adults with HIV with sustained viral load non-suppression on dolutegravir, lamivudine, and tenofovir in eastern, central, southern, and western Africa: a modelling study

作者：Andrew Phillips, Loveleen Bansi‐Matharu, Joep J. van Oosterhout, Emily P. Hyle, David van de Vijver, Roger D. Kouyos, Steven Y. Hong, Helen Chun, Elliot Raizes, Rami Kantor, Michael R. Jordan, Marco Vitória, Nathan Ford, Owen Mugurungi, Tsitsi Apollo, Pugie Tawanda Chimberengwa, Graeme Meintjes, Mark Siedner, Jens Lundgren, Jonathan Schapiro, Charles Flexner, Tom Loosli, Valentina Cambiano, Jennifer Smith, Rui Xia, Suzanne M. McCluskey, Sandrine Mewoabi, Alexandra Calmy, Serge Paul Eholié, Paul Revill · 发表于：The Lancet HIV · 年份：2025 · DOI：10.1016/s2352-3018(25)00068-2 · 被引用次数：6 · 研究领域：HIV/AIDS drug development and treatment、HIV/AIDS Research and Interventions、HIV-related health complications and treatments

BACKGROUND: In Africa, for people with HIV on a dolutegravir-based regimen with a viral load of more than 1000 copies per mL despite enhanced adherence counselling, the appropriate course of action is uncertain. We aimed to evaluate the predicted effects of alternative antiretroviral regimen switching options in this population, including consideration of cost-effectiveness. METHODS: We used an existing individual-based model to simulate risk and experience of HIV in 100 000 adults alive between 1989 and 2076. Using sampling of parameter values, we created 1000 setting-scenarios, reflecting the uncertainty in assumptions and a range of settings similar to those seen in eastern, central, southern, and western Africa. For each setting-scenario, we predicted the outcomes from the three alternative policies for people with sustained viral load non-suppression on a dolutegravir-containing regimen from 2026: a switch to a protease inhibitor-based regimen (switch policy), a switch to a protease inhibitor-based regimen only if HIV drug resistance testing beforehand shows integrase inhibitor resistance (resistance test policy), and no switch with no HIV drug resistance test (no switch policy). We considered predicted outcomes over 10-year and 50-year periods from 2026, used a 3% discount rate, and a cost-effectiveness threshold of US$500 per disability-adjusted life-year (DALY) averted. Ritonavir-boosted darunavir costs $210 per year, and dolutegravir less than $20. We assumed a cost ...