Evidence map›Paper›PMID 30503325›Full record

ArticleThe lancet. HIV2019

Risks and benefits of dolutegravir-based antiretroviral drug regimens in sub-Saharan Africa: a modelling study.

Andrew N Phillips, Francois Venter, Diane Havlir, Anton Pozniak, Daniel Kuritzkes, Annemarie Wensing, Jens D Lundgren, Andrea De Luca, Deenan Pillay, John Mellors and 14 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The lancet. HIV, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 82 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
82citing papers in PubMed, 2 pooled it
8.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

82 citing papers in PubMed, 2 syntheses or guidelines pooled it, 125 citations in OpenAlex.

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  20. Update on HIV prevention and management in pregnancy Number 10 - 2025.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2025
    Article

22 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

24 authors at 15 institutions in 9 countries.

Andrew N PhillipsUniversity College London, London, UK. Electronic address: andrew.phillips@ucl.ac.uk.
Francois VenterWits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Diane HavlirUniversity of California, San Francisco, CA, USA.
Anton PozniakChelsea and Westminster Hospital, London, UK; London School of Hygiene & Tropical Medicine, London, UK.
Daniel KuritzkesBrigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Annemarie WensingWits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa; University Medical Center, Utrecht, Netherlands.
Jens D LundgrenRigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Andrea De LucaUniversity of Siena, Siena, Italy.
Deenan PillayAfrica Health Research Institute, Mtubatuba, South Africa.
John MellorsUniversity of Pittsburgh, Pittsburgh, PA, USA.
Valentina CambianoUniversity College London, London, UK.
Loveleen Bansi-MatharuUniversity College London, London, UK.
Fumiyo NakagawaUniversity College London, London, UK.
Thokozani KaluaMinistry of Health, Lilongwe, Malawi.
Andreas JahnMinistry of Health, Lilongwe, Malawi; University of Washington, Seattle, WA, USA.
Tsitsi ApolloMinistry of Health and Child Care, Harare, Zimbabwe.
Owen MugurungiMinistry of Health and Child Care, Harare, Zimbabwe.
Polly ClaydenHIV i-Base, London, UK.
Ravindra K GuptaUniversity College London, London, UK.
Ruanne BarnabasUniversity of Washington, Seattle, WA, USA.
Paul RevillUniversity of York, York, UK.
Jennifer CohnElizabeth Glaser Paediatric AIDS Foundation, Geneva, Switzerland.
Silvia BertagnolioWorld Health Organization, Geneva, Switzerland.
Alexandra CalmyUniversity of Geneva, Geneva, Switzerland.
University College London · GBMinistry of Health and Child Welfare · ZWUniversity of the Witwatersrand · ZAUniversity of Washington · USAfrica Health Research Institute · ZAHarvard University · USLondon School of Hygiene & Tropical Medicine · GBMinistry of Health · MWRigshospitalet · DKUniversity of California, San Francisco · USUniversity of Geneva · CHUniversity of Pittsburgh · USUniversity of Siena · ITUniversity of York · GBWorld Health Organization · CH

Funding

University of Washington/Fred Hutch Center for AIDS ResearchP30AI027757 · NIAID · UNIVERSITY OF WASHINGTON · PI Kenneth Sherr · 1988 to 2026
$104.9M
NIAID NIH HHS P30 AI027757World Health Organization 001
6 · The paper itself

Abstract

backgroundThe integrase inhibitor dolutegravir could have a major role in future antiretroviral therapy (ART) regimens in sub-Saharan Africa because of its high potency and barrier to resistance, good tolerability, and low cost, but there is uncertainty over appropriate policies for use relating to the potential for drug resistance spread and a possible increased risk of neural tube defects in infants if used in women at the time of conception. We used an existing individual-based model of HIV transmission, progression, and the effect of ART with the aim of informing policy makers on approaches to the use of dolutegravir that are likely to lead to the highest population health gains.

methodsWe used an existing individual-based model of HIV transmission and progression in adults, which takes into account the effects of drug resistance and differential drug potency in determining viral suppression and clinical outcomes to compare predicted outcomes of alternative ART regimen policies. We calculated disability adjusted life-years (DALYs) for each policy, assuming that a woman having a child with a neural tube defect incurs an extra DALY per year for the remainder of the time horizon and accounting for mother-to-child transmission. We used a 20 year time horizon, a 3% discount rate, and a cost-effectiveness threshold of US$500 per DALY averted.

findingsThe greatest number of DALYs is predicted to be averted with use of a policy in which tenofovir, lamivudine, and dolutegravir is used in all people on ART, including switching to tenofovir, lamivudine, and dolutegravir in those currently on ART, regardless of current viral load suppression and intention to have (more) children. This result was consistent in several sensitivity analyses. We predict that this policy would be cost-saving.

interpretationUsing a standard DALY framework to compare health outcomes from a public health perspective, the benefits of transition to tenofovir, lamivudine, and dolutegravir for all substantially outweighed the risks.

fundingBill & Melinda Gates Foundation.

Indexed as

AdolescentAdultAfrica South of the SaharaAntiretroviral Therapy, Highly ActiveDevelopmental DisabilitiesDolutegravirDrug Resistance, ViralFemaleHeterocyclic Compounds, 3-RingHIV InfectionsHIV Integrase InhibitorsHumansMaleMiddle AgedOxazinesPiperazinesDolutegravirHeterocyclic Compounds, 3-RingHIV Integrase InhibitorsOxazinesPiperazinesPyridones

Identifiers

PMID30503325
PMCPMC6361866
OpenAlexW2902025352

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.