An observational study in HIV-1-infection, sponsored by Swiss Tropical & Public Health Institute. Completed at 2 sites in Lesotho. Per ClinicalTrials.gov, last updated 2023-05-23.
Sponsored by Swiss Tropical & Public Health Institute · Observational
DO-REAL is an observational cohort study assessing the large-scale roll-out of the antiretroviral drug dolutegravir (DTG) in Lesotho.
DTG has been shown to have low side-effects and superior treatment outcomes for people living with HIV-1 when compared to other antiretroviral drugs currently in use in low-income countries. The use of DTG in first-line antiretroviral therapy (ART) regimens was recommended by the World Health Organisation in 2018 and adopted by the Ministry of Health in Lesotho in 2019. While DTG-based ART regimens have led to promising health outcomes in high-income and clinical trial settings, certain concerns remain regarding the risk of ART-experienced patients transitioning to a DTG-based ART regimen being placed on a functional monotherapy (increasing the otherwise low risk of viral resistance to DTG) as well as side-effects including psychological symptoms and weight gain.
Thus, the DO-REAL study intends to address these concerns and provide data on health outcomes of HIV patients on DTG in a "real-life" high-prevalence setting.
SUMMARY: DO-REAL is an observational cohort study assessing the large-scale roll-out of the antiretroviral drug dolutegravir (DTG) in Lesotho.
BACKGROUND: DTG is a second-generation integrase strand transfer inhibitor with low side-effects and superior treatment outcomes for people living with HIV-1 when compared to other antiretroviral drugs currently in use in low-income countries. Though some cases have been described, HIV-1 resistance to DTG is rare in clinical settings when DTG is used as part of a combination therapy. The use of DTG in first-line antiretroviral therapy (ART) regimens was recommended by the World Health Organisation in 2018 and was adopted by the Ministry of Health in Lesotho in 2019. DTG now forms part of the recommended first-line therapy for many ART-naïve patients in Lesotho. In addition, many patients on a non-DTG-based first-line ART regimen will be transitioned to a DTG-based regimen.
OBJECTIVES: Despite the positive health outcomes observed in patients receiving DTG-based ART in high-income countries and in clinical trial settings, there is little data on virologic outcomes of patients on DTG during large-scale implementation in low- and lower middle-income countries. Concerns remain regarding the risk that some patients transitioning to a DTG-based regimen will be placed on a functional monotherapy. Furthermore, there are concerns as to psychological side-effects and observed weight gain. This observational study aims to assess the virologic outcomes (viral suppression rates as well as potential drug resistance) as well as side-effects of people living with HIV-1 and transitioning to a DTG-based ART regimen in Lesotho.
DO-REAL has two major objectives:
METHODS: DO-REAL is a cohort study enrolling people living with HIV who are initiating or are eligible (according to national guidelines and the local implementation thereof) to initiate a DTG-based antiretroviral therapy (ART) regimen. The study will take place at three hospitals in two districts (Butha-Buthe, Mokhotlong) in Lesotho, and aims to enrol over 2000 participants. Viral loads will be measured on the day of initiating a DTG-based regimen (or on the day this was offered), as well as four, 12 and 24 months thereafter. In a post-hoc analysis, samples will be tested for drug resistance in samples where the viral load permits (approx. ≥100 c/mL). A subset of participants will complete screenings for depression, general health, and HIV-related symptoms.
3,035 studies on the registry are indexed under Acquired Immunodeficiency Syndrome; 306 are open to participants now.
This study's enrollment of 1,433 is above the median of 287 across 503 observational studies indexed under Acquired Immunodeficiency Syndrome.
Browse Acquired Immunodeficiency Syndrome studies →Swiss Tropical & Public Health Institute is the lead sponsor of 58 studies on the registry; 9 are open to participants now.
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Participants will be enrolled at two government hospitals and one missionary hospital in two districts (Butha-Buthe and Mokhotlong) in Lesotho.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
The human immunodeficiency virus, which weakens the immune system.
Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.
HIV
The human immunodeficiency virus, which weakens the immune system.
Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
HIV-1-positive individuals eligible to receive a DTG-based ART regimen at enrolment.
Drug: Dolutegravir
Eligibility to receive DTG-based ART at enrolment (i.e., initiation or offer to initiate DTG-based ART)
Virologic outcomes after programmatic transition to DTG-containing regimens
Viral load
Time frame: 4 months after initiation of a DTG-containing regimen
Quality of life screening score (change from baseline)
12-Item Short Form Health Survey (SF-12; 12-item index in which questions are scored and weighted into 2 subscales, physical health and mental health; scores can range from 0-100 with higher scores indicating higher physical or mental health)
Time frame: Change between time of initiation of a DTG-containing ART regimen and 4 months thereafter
Depression screening score (change from baseline)
Patient Health Questionnaire-9 (PHQ-9; 9-item index with each item scored 0-3, providing a 0-27 severity score with a higher score indicating higher severity)
Time frame: Change between time of initiation of a DTG-containing ART regimen and 4 months thereafter
HIV symptom screening score (change from baseline)
Modified HIV Symptom Index (21-item index with each item scored 0-4, providing a 0-84 severity score with a higher score indicating higher severity)
Time frame: Change between time of initiation of a DTG-containing ART regimen and 4 months thereafter
Virologic status at programmatic transition to DTG-containing regimens
Viral load (post-hoc analysis)
Time frame: On day of initiation of a DTG-containing regimen
Viral drug resistance at programmatic transition to DTG-containing regimens
HIV-1 drug resistance (assessed by Sanger sequencing) in the case of an unsuppressed viral load (post-hoc analysis)
Time frame: On day of initiation of a DTG-containing ART regimen
Weight (change from baseline)
Change from time of enrolment; median and interquartile range; in kg
Time frame: On day of initiation of a DTG-containing ART regimen and 4, 12 and 24 months thereafter
Reasons for discontinuation of a DTG-containing regimen
Reasons for discontinuing a DTG-containing regimen as noted in medical records, where applicable
Time frame: Up to 24 months after enrolment
Long-term virologic outcomes after programmatic transition to DTG-containing regimens
Viral load
Time frame: 12 and 24 months after initiation of a DTG-containing regimen
Viral drug resistance after programmatic transition to DTG-containing regimens
HIV-1 drug resistance (assessed by Sanger sequencing) in the case of an unsuppressed viral load
Time frame: 4, 12 and 24 months after initiation of a DTG-containing regimen
Plan to share: Yes — Pseudonymized dataset for the published manuscripts "Viral suppression after transition from nonnucleoside reverse transcriptase inhibitor- to dolutegravir-based antiretroviral therapy: A prospective cohort study in Lesotho (DO-REAL study)" and "Dolutegravir in Real Life: self-reported mental and physical health outcomes after transitioning from efavirenz- to dolutegravir-based antiretroviral therapy in a prospective cohort study in Lesotho" are publicly available on Zenodo: https://zenodo.org/record/5948369 https://zenodo.org/record/6654462
This study is completed, as verified in Oct 2022. You cannot join it, but the record below documents what was studied.
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Acquired Immunodeficiency Syndrome →
Swiss Tropical & Public Health Institute