Two years after it was announced that ARV medicine dolutegravir would become part of standard first-line HIV treatment in SA, it is finally reaching significant numbers of people. But new research about a worrying side-effect has muddied its reputation
Patients, particularly women, are fast gaining weight.
Dolutegravir is more forgiving, meaning that if you miss a dose or two you won’t get resistance. With efavirenz, there is a low bar for resistance; just missing a few doses can cause resistance.In a 2017 press statement, the health department said that switching the country’s millions of antiretroviral therapy patients to dolutegravir would save South Africa R11 billion over the next six years.Viral load is the amount of virus in a patient’s blood.
Additionally, she says, dolutegravir does not have many of the side-effects associated with the efavirenz regimen, including insomnia, dizziness and depression.Despite these advantages, the nationwide transition to dolutegravir only began in earnest in February 2020, almost two years after the initial planned introduction, according to health department spokesperson Popo Maja.
In December 2019, four provinces began the transition to the dolutegravir regimen and they were all required to get women to sign the risk acknowledgement form. “Women are not baby-making machines. No other drug has been held to the standard that dolutegravir was held to,” says Chandiwana. But just as the programme seemed to overcome this hurdle, the Covid-19 coronavirus and subsequent lockdown occurred the following month, delaying the transition even more.The risk of birth defects link turned out to be negligible, especially when compared to a side-effect only discovered more recently – weight gain.
The Advance trial has three arms – one looks at the existing first-line efavirenz-based treatment; the second looks at dolutegravir with tenofovir and lamivudine ; and the third looks at dolutegravir with a new version of tenofovir and lamivudine.
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