Dolutegravir-based HIV therapy: limited effect on neuropsychiatric markers following regimen switch

  • Chan P & al.
  • AIDS Res Ther
  • 7 Jan 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Switching to a dolutegravir (DTG)-based antiretroviral therapy (ART) regimen does not appear to worsen neuropsychiatric adverse events (NP-AEs) in virally suppressed, HIV-infected males. 
  • Modest increases in somatic depression measures (Patient Health Questionnaire-9 [PHQ-9]) were observed.

Why this matters

  • Despite previous reports, DTG-based ART results in relatively stable NP-AEs, although clinicians should follow patients for potential somatic symptoms (headache, dizziness, insomnia, restlessness).

Key results

  • 254 participants (99% Thai; 95% male); median age, 30 (interquartile range [IQR], 25-36) years.
  • Median preregimen switch duration: 144 (IQR, 24-92) weeks; 82% were on efavirenz (EFV)-based ART.
  • 2Q-Depression screen and Distress Thermometer (DT) scores unchanged (P>.10).
  • PHQ-9 increased pre- (5; IQR, 1-7) vs postswitch (5; IQR, 2-8) in upper IQR (P=.009).
  • Increases observed in PHQ-9 subscores, pre- (2; IQR, 0-3) vs postswitch (2; IQR, 1-3); P=.007.
  • Multivariate: preexisting viral suppression (mean difference, −3.2; P=.006), PHQ-9 >10 (mean difference, −2.7; P<.001 independently associated with phq-9 score decline.>

Study design

  • Follow-up analysis of prospectively collected data on HIV-infected adults switching from EFV-l to DTG-based ART describing affective, somatic dimensions of depression, and neurocognitive performance pre-/post-DTG switch.
  • Funding: Henry M. Jackson Foundation for the Advancement of Military Medicine, US Department of Defense.

Limitations

  • Limited generalizability.
  • No control group.