PMID- 36700216 OWN - NLM STAT- MEDLINE DCOM- 20230130 LR - 20230202 IS - 1664-3224 (Electronic) IS - 1664-3224 (Linking) VI - 13 DP - 2022 TI - A retrospective clinical study of dolutegravir- versus efavirenz-based regimen in treatment-naive patients with advanced HIV infection in Nanjing, China. PG - 1033098 LID - 10.3389/fimmu.2022.1033098 [doi] LID - 1033098 AB - Currently, there are limited data related to the efficacy and safety of ART regimens, as well as factors influencing immune recovery in antiretroviral therapy (ART)-naive patients with advanced HIV infection, especially in China. We designed a single-center, retrospective cohort study from March 1, 2019, to May 31, 2022, at The Second Hospital of Nanjing, China. ART-naive adults with advanced HIV infection (CD4+ T-cell count < 200 cells/muL) who met the study criteria were included. The plasma viral load (VL), CD4+ T-cell count, CD4/CD8 ratio, treatment discontinuation, and immune reconstitution inflammatory syndrome (IRIS) events were collected to compare the efficacy and safety of the dolutegravir (DTG) and the efavirenz (EFV) regimens. Factors of immune recovery were analyzed using the Cox regression model. Study enrolled 285 ART-naive adults with advanced HIV-1 infection, of which 95 (33.3%) started regimens including DTG and 190 (66.7%) were treated with EFV. After ART initiation, the proportion of patients with HIV-1 RNA < 50 copies/mL was higher (22.5% versus 6.5%, P < 0.001) in those on DTG-based regimens at month 1, but no significant difference at other follow-up points. Compared to the baseline, the median CD4+ T-cell count and CD4/CD8 ratio increased significantly during follow-up both in the EFV and the DTG groups. However, the CD4+ T-cell count increased greater in patients on DTG-based regimens at months 6, 12, 24, and 36 (P < 0.05). A total of 52 (18.2%) patients discontinued treatment, with no significant difference between ART regimens in treatment discontinuation rates. Only 7 patients reported IRIS, without significant difference between ART regimens (P=0.224). Overall, 34.0% (97/285) achieved a CD4+ T-cell count >/= 350 cells/muL during follow-up. Age (P < 0.001), baseline CD4+ T-cell count (P < 0.001), baseline VL (P < 0.001) and ART regimens (P = 0.019) were associated with the CD4+ T-cell count >/= 350 cells/muL after adjusting for potential confounders. Among ART-naive adults with advanced HIV infection, it appeared that DTG-based regimens were better options for initial therapy compared to regimens including EFV; in addition, ART regimens, age, baseline VL and CD4+ T-cell count were associated with immune recovery. CI - Copyright (c) 2023 Zhong, Li, Qi, Su, Yu, Lv, Ye, Zhang, Xu, Cheng, Chen and Wei. FAU - Zhong, Mingli AU - Zhong M AD - Department of Infectious Disease, The Second Hospital of Nanjing, School of Public Health, Nanjing Medical University, Nanjing, China. FAU - Li, Mengqing AU - Li M AD - Department of Infectious Disease, The Second Hospital of Nanjing, School of Public Health, Nanjing Medical University, Nanjing, China. FAU - Qi, Mingxue AU - Qi M AD - Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China. FAU - Su, Yifan AU - Su Y AD - Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China. FAU - Yu, Nawei AU - Yu N AD - Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China. FAU - Lv, Ru AU - Lv R AD - Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China. FAU - Ye, Zi AU - Ye Z AD - Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China. FAU - Zhang, Xiang AU - Zhang X AD - Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China. FAU - Xu, Xinglian AU - Xu X AD - Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China. FAU - Cheng, Cong AU - Cheng C AD - Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China. FAU - Chen, Chen AU - Chen C AD - Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China. FAU - Wei, Hongxia AU - Wei H AD - Department of Infectious Disease, The Second Hospital of Nanjing, School of Public Health, Nanjing Medical University, Nanjing, China. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230109 PL - Switzerland TA - Front Immunol JT - Frontiers in immunology JID - 101560960 RN - 0 (Benzoxazines) RN - DKO1W9H7M1 (dolutegravir) RN - JE6H2O27P8 (efavirenz) RN - 0 (Anti-HIV Agents) SB - IM MH - Adult MH - Humans MH - *Benzoxazines/therapeutic use MH - *HIV Infections/drug therapy MH - Retrospective Studies MH - *Anti-HIV Agents/therapeutic use PMC - PMC9868135 OTO - NOTNLM OT - IRIS - immune reconstitution inflammatory syndrome OT - advanced HIV infection OT - antiretroviral therapy OT - dolutegravir OT - efavirenz OT - immune recovery COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2023/01/27 06:00 MHDA- 2023/01/28 06:00 PMCR- 2022/01/01 CRDT- 2023/01/26 02:55 PHST- 2022/09/06 00:00 [received] PHST- 2022/12/14 00:00 [accepted] PHST- 2023/01/26 02:55 [entrez] PHST- 2023/01/27 06:00 [pubmed] PHST- 2023/01/28 06:00 [medline] PHST- 2022/01/01 00:00 [pmc-release] AID - 10.3389/fimmu.2022.1033098 [doi] PST - epublish SO - Front Immunol. 2023 Jan 9;13:1033098. doi: 10.3389/fimmu.2022.1033098. eCollection 2022.