Dolutegravir, a molecule already used in the treatment of HIV, could be generalized to treat all new HIV infections, which represents two million people each year.
-1603108888.jpg "Better treatment for HIV soon to be generalized")
- An already known molecule, dolutegravir, could see its role amplified in the fight against HIV.
- This antiretroviral works better than efavirenz, another molecule, and is better accepted by patients.
HIV could be better treated in people who are resistant to treatment. Researchers from the University of British Columbia (Canada) have highlighted the benefits of dolutegravir for treating people recently infected with HIV. This study, commissioned by the World Health Organization (WHO) and published on October 16, 2020 in the online journal EClininalMedicine, is part of an update of guidelines on antiretroviral therapy for HIV. This new research aims to change international recommendations for new patients diagnosed with HIV, which would represent approximately two million people worldwide each year.
In these conclusions, she highlights the role of dolutegravir as a treatment for people newly infected with HIV. Dolutegravir is an antiviral molecule used to fight HIV. Unlike other molecules, it would be more effective, easier to take and have fewer side effects for the patient.
A suspicion of risk for pregnant women
If dolutegravir took so long to establish itself as an alternative to other treatments, it is in particular for a risk of side effects in pregnant women. “WHO research for 2016 suggests that dolutegravir is effective and well tolerated, but its efficacy and safety among key populations, such as pregnant women and people living with both HIV and TB, remain uncertaincomments Dr. Steve Kanters, PhD at the School of Public Health at the University of British Columbia. In 2018, new research warned of a potentially serious increased risk of neural tube defects in the children of women who became pregnant while on this treatment..” Because of this possible dangerousness, another molecule, efavirenz, was preferred to dolutegravir for many years.
In order to remove the doubt on its potential harmfulness, Canadian researchers carried out a meta-analysis of research from 68 clinical trials of antiretroviral therapy. They found that the effects of dolutegravir were superior to those of efavirenz, particularly in terms of viral load suppression, tolerance and safety. “We found an increase of around 5% in the likelihood of viral suppression, which means that more people who start treatment will be able to successfully control their HIV”, says Steve Kanters.
A chance for patients resistant to other treatments
In addition, dolutegravir has the advantage of being more effective in certain people who are resistant to antiretrovirals from the NNRTI family (non-nucleoside reverse transcriptase inhibitors) of which efavirenz is a member. Finally, this meta-analysis also demonstrates that dolutegravir has a similar rate of adverse effects in pregnant women (0.3%). “New data on neural tube defects show that the risk from dolutegravir is much more tolerable than previously thought and should allay initial fears about the drug. Dolutegravir looks set to remain the preferred treatment for people newly diagnosed with HIVwelcomes Steve Kanters. However, it is important to recognize the good that efavirenz has done over the past two decades as it has contributed to the expansion of antiretroviral therapy worldwide..”
Further studies will need to determine if there are other benefits of switching from efavirenz to dolutegravir in people who were unable to control the infection. For now, the only side effect of dolutegravir is weight gain, which researchers are already working on.
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