Rollout of dolutegravir-based antiretroviral therapy in sub-Saharan Africa and its public health implications

Abstract

Globally, approximately 33 million people are living with Human Immunodeficiency Virus (HIV) and more than 60% of them live in sub-Saharan Africa. Widespread availability of antiretroviral treatment (ART) has reduced morbidity and mortality among people living with HIV (PLHIV). The increase in life expectancy in PLHIV has been associated with an increased burden of non-communicable diseases (NCDs), mainly being metabolic disorders [1]. PLHIV have an increased risk of developing NCDs since traditional risk factors for NCDs such as obesity, genetic predisposition and sedentary life intersect with HIV-specific risk factors such as long-term exposure to ART and chronic inflammation [2]. Integrase-strand-transfer inhibitors (INSTI)-based regimens have recently been rolled out as the new first-line treatment in most low and middle-income countries due to their excellent safety profile, lower price, and sustained treatment success compared to the currently used ART regimens [3]. In sub-Saharan Africa, most of the current guidelines recommends the use of dolutegravir-based regimens as the first line ART among PLHIV [3]. However, there is a lack of studies to evaluate long-term side effects of dolutegravir-based regimens among PLHIV living in low and middle-income countries.