Abstract
IntroductionDolutegravir (DTG)-based antiretroviral therapy (ART) is currently the first-line treatment for people living with HIV. Neuropsychiatric adverse events (NP-AEs) have been reported with DTG but neuropsychiatric symptoms have not been systemically quantified using structured scales. This study examined mood and cognitive parameters before and after a planned transition from non-DTG to DTG-based ART within a longitudinal study of acute HIV infection (AHI).MethodsRV254 AHI cohort participants on ≥ 24 weeks of ART initiated at AHI underwent sequential assessments before and after the switch including: (1) Patient Health Questionnaire-9 (PHQ-9), a 9-item survey (scores 0–27) that evaluates somatic and affective/cognitive symptoms of depression; (2) a 2-Questions screening that has been validated locally for depression; (3) Distress Thermometer (scores 0–10); and 4) administration of a 4-test neurocognitive battery sensitive to HIV.Results254 individuals (95% male, median age 30) switched to a DTG-based regimen after a median 144 weeks of ART. Serial assessments were completed at a median of 19 weeks before and 37 weeks after DTG. There was a modest but statistically significant increase in PHQ-9 scores after DTG (pre-switch: 5 [IQR 1–7] vs. Post-switch: 5 [IQR 2–8], p = 0.009). The percentage of participants with at least moderate depression (PHQ-9 ≥ 10) increased from 10 to 16% (p = 0.006), but the frequency of moderate-severe depression (PHQ-9 ≥ 15) remained unchanged (3%). No volunteer reported NP-AEs within the study period. Somatic symptoms of depression increased more than cognitive/affective symptoms. Plasma viral suppression (HIV-1 RNA < 50; p = 0.005) and PHQ-9 ≥ 10 (p < 0.001) before switch were linked to lower PHQ-9 scores after DTG in multivariable analysis. Performance on all neuropsychological tests, except grooved pegboard test, improved modestly after DTG (all p < 0.05).ConclusionAfter a median duration of 37 weeks of DTG use, there was a modest increase in the higher quartile of PHQ-9. This increase was associated with a rise in moderate depression symptoms but not the more severe forms of depression on PHQ-9. No clinically relevant NP-AEs were reported. Pre-existing depression was not associated with subsequent worsening of symptoms after DTG. Cognitive test performance improved post-DTG but could be due to practice effect.
Highlights
Dolutegravir (DTG)-based antiretroviral therapy (ART) is currently the first-line treatment for people living with HIV
The World Health Organization recently recommended the use of DTG-based regimens as first-line antiretroviral therapy (ART) for people living with HIV (PLWH)
The median duration of ART prior to the planned switch was 144 [interquartile range (IQR) 24–192] weeks; 82% were previously on EFV-based ART, 13% were on a boosted protease inhibitor-based ART, 5% were on rilpivirine-based ART, and one individual was on a raltegravir-based regimen
Summary
Dolutegravir (DTG)-based antiretroviral therapy (ART) is currently the first-line treatment for people living with HIV. The World Health Organization recently recommended the use of DTG-based regimens as first-line antiretroviral therapy (ART) for people living with HIV (PLWH). Prior studies including self-reported NP-AEs described increased rates of insomnia in a minority of individuals after starting a DTG-based regimen. We previously reported that DTG was well tolerated with few discontinuations among young men who switched from a non-DTG to a DTG-based regimen [5]. This follow-up report focuses on affective and somatic dimensions of depression, and cognitive performance before and after switch to DTG
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