Effectiveness and safety of antiretrovirals for switch therapy in human immunodeficiency virus

Abstract

Introduction: Increase in the life expectancy of people living with HIV has led to the search for simplified antiretroviral therapy alternatives of lower toxicity potential which foster adherence and thus contribute to achieve viral load undetectability goals. Several options have been proposed in recent years, and it is necessary to be aware of their mid- and long-term effectiveness.

Objective: Determine the effectiveness and safety of switch therapy in patients aged over 12 years who live with the human immunodeficiency virus.

Methods: A bibliographic search was conducted in electronic databases and the gray literature. Combined estimation was made of the measure of outcomes for viral load maintenance (less than 50 copies per milliliter), CD4⁺ T lymphocyte levels and adverse events of switch therapy versus continuing standard therapy.

Results: Six randomized clinical trials were included which compared switch therapy (rilpivirine / emtricitabine / tenofovir alafenamide, dolutegravir / rilpivirine, abacavir / dolutegravir / lamivudine) with continuing standard therapy. Viral load maintenance was not different between the groups (OR: 0.77; CI 95% 0.59, 1.02), nor was there any difference in the CD4⁺ T lymphocyte count (DME: 6.76; CI 95% -5.05;18.57) or the serious adverse events (OR: 1.03; CI 95% 0.74; 1.42).

Conclusions: Differences were not found in the effectiveness and safety of switch therapy versus continuing standard therapy. Results support the use of these therapeutic strategies to foster adherence to antiretroviral therapy.