{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:02:11Z","timestamp":1785409331909,"version":"3.56.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2023,11,16]],"date-time":"2023-11-16T00:00:00Z","timestamp":1700092800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-051067"],"award-info":[{"award-number":["INV-051067"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"publisher","award":["CL-2022-13-005"],"award-info":[{"award-number":["CL-2022-13-005"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We aimed to compare clinical outcomes after viremia between dolutegravir vs efavirenz-based first-line antiretroviral therapy (ART) as evidence is lacking outside clinical trials in resource-limited settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort analysis with routine data from 59 South African clinics. We included people with HIV aged \u226515 years receiving first-line tenofovir disoproxil fumarate, lamivudine, dolutegravir (TLD) or tenofovir disoproxil fumarate, emtricitabine, efavirenz (TEE) and with first viremia (\u226550 copies\/mL) between June and November 2020. We used multivariable modified Poisson regression models to compare retention in care and viral suppression (&amp;lt;50 copies\/mL) after 12 months between participants on TLD vs TEE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At first viremia, among 9657 participants, 6457 (66.9%) were female, and the median age (interquartile range [IQR]) was 37 (31\u201344) years; 7598 (78.7%) were receiving TEE and 2059 (21.3%) TLD. Retention in care was slightly higher in the TLD group (84.9%) than TEE (80.8%; adjusted risk ratio [aRR], 1.03; 95% CI, 1.00\u20131.06). Of 6569 participants retained in care with a 12-month viral load, viral suppression was similar between the TLD (78.9%) and TEE (78.8%) groups (aRR, 1.02; 95% CI, 0.98\u20131.05). However, 3368 participants changed ART during follow-up: the majority from TEE to first-line TLD (89.1%) or second-line (TLD 3.4%, zidovudine\/emtricitabine\/lopinavir-ritonavir 2.1%). In a sensitivity analysis among the remaining 3980 participants who did not change ART during follow-up and had a 12-month viral load, viral suppression was higher in the TLD (78.9%) than TEE (74.9%) group (aRR, 1.07; 95% CI, 1.03\u20131.12).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among people with viremia on first-line ART, dolutegravir was associated with slightly better retention in care and similar or better viral suppression than efavirenz.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofad583","type":"journal-article","created":{"date-parts":[[2023,11,16]],"date-time":"2023-11-16T13:01:30Z","timestamp":1700139690000},"source":"Crossref","is-referenced-by-count":8,"title":["Clinical Outcomes After Viremia Among People Receiving Dolutegravir vs Efavirenz-Based First-line Antiretroviral Therapy in South Africa"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5074-2315","authenticated-orcid":false,"given":"Kwabena","family":"Asare","sequence":"first","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA) , Durban, KwaZulu-Natal , South Africa"},{"name":"Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal , Durban, KwaZulu-Natal , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5373-2086","authenticated-orcid":false,"given":"Lara","family":"Lewis","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA) , Durban, KwaZulu-Natal , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"van der Molen","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA) , Durban, KwaZulu-Natal , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukteshwar","family":"Sookrajh","sequence":"additional","affiliation":[{"name":"eThekwini Municipality Health Unit, eThekwini Municipality , Durban, KwaZulu-Natal , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thokozani","family":"Khubone","sequence":"additional","affiliation":[{"name":"eThekwini Municipality Health Unit, eThekwini Municipality , Durban, KwaZulu-Natal , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pravikrishnen","family":"Moodley","sequence":"additional","affiliation":[{"name":"Department of Virology, University of KwaZulu-Natal and National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital , Durban, KwaZulu-Natal , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0926-710X","authenticated-orcid":false,"given":"Richard J","family":"Lessells","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA) , Durban, KwaZulu-Natal , South Africa"},{"name":"KwaZulu-Natal Research and Innovation Sequencing Platform (KRISP), University of KwaZulu-Natal , Durban, KwaZulu-Natal , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8874-6661","authenticated-orcid":false,"given":"Kogieleum","family":"Naidoo","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA) , Durban, KwaZulu-Natal , South Africa"},{"name":"South African Medical Research Council (SAMRC)-CAPRISA-TB-HIV Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal Nelson R Mandela School of Medicine , Durban, KwaZulu-Natal , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phelelani","family":"Sosibo","sequence":"additional","affiliation":[{"name":"eThekwini Municipality Health Unit, eThekwini Municipality , Durban, KwaZulu-Natal , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4530-234X","authenticated-orcid":false,"given":"Nigel","family":"Garrett","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA) , Durban, KwaZulu-Natal , South Africa"},{"name":"Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal , Durban, KwaZulu-Natal , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6072-1430","authenticated-orcid":false,"given":"Jienchi","family":"Dorward","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA) , Durban, KwaZulu-Natal , South Africa"},{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford , Oxfordshire , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,11,16]]},"reference":[{"key":"2023122910083631500_ofad583-B1","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/S1473-3099(17)30681-3","article-title":"Effect of HIV-1 low-level viraemia during antiretroviral therapy on treatment outcomes in WHO-guided South African treatment programmes: a multicentre cohort study","volume":"18","author":"Hermans","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2023122910083631500_ofad583-B2","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s41256-019-0120-4","article-title":"Treatment failure and associated factors among first line patients on highly active antiretroviral therapy in Ethiopia: a systematic review and 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