Advancements in HIV Treatment: ART Progress

Antiretroviral therapy, commonly known as Art, is a treatment for people living with HIV. Over the years, ART has improved, becoming more effective, safer, and cheaper. Since the mid-1990s, a combination of different medications has been used to treat HIV. One current popular treatment involves using an integrase inhibitor called dolutegravir (DTG) along with two other drugs called nucleoside reverse transcriptase inhibitors (NRTIs). This treatment is now recommended for people starting ART and for those who did not succeed on previous treatments.

#Previous Treatments

In the past, another medication called efavirenz (EFV) was often the first choice for treatment. For those needing a second treatment plan, doctors commonly used ritonavir-boosted protease inhibitors, like atazanavir (ATV/r) or lopinavir (LPV/r), also combined with NRTIs. Research has shown that DTG works faster to reduce the virus in the body than these older options. Additionally, DTG has fewer side effects and is less likely to lead to drug resistance compared to the previous treatments.

#The Issue of Treatment Success

The success of ART can depend on several factors. One of the biggest issues is Adherence, which means how well patients stick to their treatment plans. Poor adherence often leads to treatment failure and can cause the virus to become resistant to the medications. Other factors that can affect treatment success include high amounts of the virus in the body, low immune system counts (CD4 cells), existing health problems like tuberculosis, and a younger age.

A new fixed-dose combination called TLD includes DTG, lamivudine (3TC), and tenofovir disoproxil fumarate (TDF). This combination may help patients stay on track with their treatment and improve success rates.

#Comparing Treatments

In studies, DTG has shown similar effectiveness in suppressing the virus compared to boosted protease inhibitors for both people just starting ART and those switching to a new regimen. When people switch to a second line of ART, such as DTG, their Viral Load usually drops to undetectable levels within a few weeks to a few months. However, there is limited information on how well patients do on second-line ART, especially in areas like sub-Saharan Africa.

#A Study in Zimbabwe

A specific study looked at patients in Zimbabwe to compare how well patients performed on different ART regimens. The study focused on people switching to DTG- or ATV/r-based second-line ART after failing on previous treatments and those starting EFV-based first-line ART.

The study analyzed data from Newlands Clinic in Harare, which serves around 7,300 patients. The clinic has been helping people with HIV since 2010. For many years, the first choice for treatment was usually EFV-based ART, and ATV/r was often used for second-line treatment. Since 2019, DTG has become the treatment of choice for both first- and second-line ART.

#Data Collection and Analysis

Researchers gathered patient information and monitored their progress over time. They looked at demographic details, immune system counts, and viral load measurements. These measurements help doctors understand how well a treatment is working. The clinic used a secure electronic system to ensure patient privacy while collecting data.

Patients gave informed consent, allowing their information to be used for research purposes. Researchers included patients aged 12 and older who had been on a treatment for at least 24 weeks. They monitored viral load suppression, which means reducing the virus to less than 50 copies per milliliter of blood.

#Findings on Viral Load Suppression

The findings showed that patients receiving first-line EFV-based ART had the highest rates of viral suppression from weeks 24 to 96. Those who switched to DTG-based second-line ART showed better viral suppression shortly after switching, compared to those on ATV/r. However, for longer follow-ups, DTG and ATV/r had similar suppression rates, while EFV showed better rates overall.

The results indicated that patients using DTG had better success soon after switching, but the difference in effectiveness decreased over time. Older patients and those with more CD4 cells at the start had higher chances of achieving viral suppression. However, male patients tended to have lower odds of success than female patients.

#Younger Patients and Treatment Challenges

The study also highlighted some challenges for younger patients. Those in the younger age groups were less likely to achieve viral suppression across all treatment regimens. Younger individuals might struggle with sticking to treatment plans. This indicates a need for more tailored support for younger patients to help them improve their adherence to treatment.

#Conclusion and Recommendations

In conclusion, patients switching to second-line ART faced challenges in achieving viral suppression compared to those starting first-line ART. Achieving better outcomes is especially crucial for individuals with a history of treatment failure. Factors like age and immune system strength were strong indicators of treatment success.

To improve treatment rates, it is essential to focus on support for young people and others who switch regimens after not succeeding with earlier treatments. More resources and programs are needed to help these patients stay on track with their ART, ensuring that they can achieve and maintain viral suppression.

While the study had some limitations, including the lack of adherence measures and varying treatment periods, it provided valuable insights into the effectiveness of ART regimens in Zimbabwe. Continued research and support are necessary to enhance treatment outcomes for all people living with HIV.