Persistent sex disparities in access to dolutegravir‐based antiretroviral therapy in Latin America and the Caribbean: results from a retrospective observational study using data from 2017 to 2022

作者：Fernanda Fernandes Fonseca, Paridhi Ranadive, Bryan E. Shepherd, Flávia Gomes Faleiro Ferreira, Maria F. Rodríguez, Daisy Maria Machado, Vanessa Rouzier, Diana E. Varela, Fernanda Maruri, Peter F. Rebeiro, Beatriz Grinsztejn, Sandra Wagner Cardoso, Valdiléa G. Veloso, Jessica L. Castilho, Emília M. Jalil, CCASAnet · 发表于：Journal of the International AIDS Society · 年份：2025 · DOI：10.1002/jia2.26470 · 被引用次数：3 · 研究领域：HIV/AIDS drug development and treatment、HIV/AIDS Research and Interventions、Pregnancy and Medication Impact

INTRODUCTION: Despite its reversal in July 2019, the World Health Organization warning issued in May 2018 of potential teratogenicity associated with dolutegravir (DTG) may have produced persistent sex disparities in access to DTG. We compared DTG uptake of people with HIV (PWH) by sex in Latin America and the Caribbean (LAC) and its potential impact on virologic outcomes. METHODS: We evaluated DTG initiation among antiretroviral therapy (ART)-naïve and -experienced cisgender PWH ≥16 years of age after DTG availability in Brazil (February/2017), Chile (August/2019), Haiti (November/2018) and Honduras (December/2018). Time was divided into pre- (before May/2018), during- (May/2018-July/2019) and post- (after July/2019) warning periods. We examined interactions of sex, age and calendar era with multivariable modified Poisson regression models and Cox proportional hazard models for the outcomes of DTG initiation among ART-naïve and ART-experienced PWH, respectively, and HIV RNA <50 copies/ml in the first year of therapy among ART-naïve PWH, adjusting for site and tuberculosis. RESULTS: Among 4622 ART-naïve PWH, 3853 (83%) initiated DTG. ART-naïve females aged 16-49 years were less likely to initiate DTG compared to males of the same age both in the pre/during-warning (adjusted prevalence ratio [aPR]: 0.75 [95% confidence interval (95% CI): 0.71-0.80]) and in the post-warning periods (aPR: 0.97 [95% CI: 0.95-1.00]). Among 16,154 ART-experienced PWH, 9236 (57%) initiated DTG. ART-...