Journal Article > Meta-AnalysisFull Text
Lancet HIV. 2015 August 11; Volume 2 (Issue 10); DOI:10.1016/S2352-3018(15)00137-X
Ford NP, Shubber Z, Meintjes GA, Grinsztejn B, Eholie SP, et al.
Lancet HIV. 2015 August 11; Volume 2 (Issue 10); DOI:10.1016/S2352-3018(15)00137-X
Journal Article > CommentaryFull Text
Lancet HIV. 2018 September 8; Volume 392 (Issue 10150); 797-798.; DOI:10.1016/S0140-6736(18)31670-2
Reuter A, Furin J
Lancet HIV. 2018 September 8; Volume 392 (Issue 10150); 797-798.; DOI:10.1016/S0140-6736(18)31670-2
Journal Article > CommentaryFull Text
Lancet HIV. 2024 August 21; Online ahead of print; DOI:10.1016/S2352-3018(24)00207-8
Flores A, Tut Chol B, Alphonse J, Hewett T
Lancet HIV. 2024 August 21; Online ahead of print; DOI:10.1016/S2352-3018(24)00207-8
Journal Article > CommentaryFull Text
Lancet HIV. 2021 December 7; Volume S2352-3018 (Issue 21); 00321-0.; DOI:10.1016/S2352-3018(21)00321-0
Barber M, Sarpatwari A, Cepuch C
Lancet HIV. 2021 December 7; Volume S2352-3018 (Issue 21); 00321-0.; DOI:10.1016/S2352-3018(21)00321-0
Journal Article > ReviewFull Text
Lancet HIV. 2024 November 1; Online ahead of print; DOI:10.1016/S2352-3018(24)00233-9
Cortes CP, Sued O, Wong WCW, Borquez A, Ssonko C, et al.
Lancet HIV. 2024 November 1; Online ahead of print; DOI:10.1016/S2352-3018(24)00233-9
Journal Article > CommentaryFull Text
Lancet HIV. 2020 July 2; DOI:32621871
Reuter A, Furin J
Lancet HIV. 2020 July 2; DOI:32621871
“We were hungry all the time”, is the first thing a 28-year-old tuberculosis survivor from rural Haiti told one of us (JF) when asked in 2017 about his experience of being treated for the disease. This patient had been cutting sugar cane to support his family of seven—all of whom lived in a one-room shack—but had to stop his gruelling labour once he became sick with tuberculosis, both because of his physical symptoms and because he had to go to the clinic daily for directly observed therapy. Without his income, his family fell into ruin and the pressing need to feed his children became his most urgent priority. “It was hard to take my treatment when the little ones were holding their bellies and crying. We lost so much to TB.”
Journal Article > CommentaryFull Text
Lancet HIV. 2015 September 24; Volume 2 (Issue 10); DOI:10.1016/S2352-3018(15)00180-0
Isaakidis P, Gupta S, Das M, Ferrer D, Nalinikanta R, et al.
Lancet HIV. 2015 September 24; Volume 2 (Issue 10); DOI:10.1016/S2352-3018(15)00180-0
Journal Article > LetterAbstract Only
Lancet HIV. 2024 October 1; Volume 11 (Issue 10); e711-e716.; DOI:10.1016/S2352-3018(24)00173-5
Venter WDF, Gandhi M, Sokhela S, Sikwese K, Bygrave H, et al.
Lancet HIV. 2024 October 1; Volume 11 (Issue 10); e711-e716.; DOI:10.1016/S2352-3018(24)00173-5
Journal Article > ResearchFull Text
Lancet HIV. 2023 May 22; Volume S2352-3018 (Issue 23); 00081-4.; DOI:10.1016/S2352-3018(23)00081-4
Griesel R, Zhao Y, Simmons B, Omar Z, Wiesner L, et al.
Lancet HIV. 2023 May 22; Volume S2352-3018 (Issue 23); 00081-4.; DOI:10.1016/S2352-3018(23)00081-4
BACKGROUND
The drug-drug interaction between rifampicin and dolutegravir can be overcome by supplemental dolutegravir dosing, which is difficult to implement in high-burden settings. We aimed to test whether virological outcomes with standard-dose dolutegravir-based antiretroviral therapy (ART) are acceptable in people with HIV on rifampicin-based antituberculosis therapy.
METHODS
RADIANT-TB was a phase 2b, randomised, double-blind, non-comparative, placebo-controlled trial at a single site in Khayelitsha, Cape Town, South Africa. Participants were older than 18 years of age, with plasma HIV-1 RNA greater than 1000 copies per mL, CD4 count greater than 100 cells per μL, ART-naive or first-line ART interrupted, and on rifampicin-based antituberculosis therapy for less than 3 months. By use of permuted block (block size of 6) randomisation, participants were assigned (1:1) to receive either tenofovir disoproxil fumarate, lamivudine, and dolutegravir plus supplemental 50 mg dolutegravir 12 h later or tenofovir disoproxil fumarate, lamivudine, and dolutegravir plus matched placebo 12 h later. Participants received standard antituberculosis therapy (rifampicin, isoniazid, pyrazinamide, and ethambutol for the first 2 months followed by isoniazid and rifampicin for 4 months). The primary outcome was the proportion of participants with virological suppression (HIV-1 RNA <50 copies per mL) at week 24 analysed in the modified intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT03851588.
FINDINGS
Between Nov 28, 2019, and July 23, 2021, 108 participants (38 female, median age 35 years [IQR 31-40]) were randomly assigned to supplemental dolutegravir (n=53) or placebo (n=55). Median baseline CD4 count was 188 cells per μL (IQR 145-316) and median HIV-1 RNA was 5·2 log10 copies per mL (4·6-5·7). At week 24, 43 (83%, 95% CI 70-92) of 52 participants in the supplemental dolutegravir arm and 44 (83%, 95% CI 70-92) of 53 participants in the placebo arm had virological suppression. No treatment-emergent dolutegravir resistance mutations were detected up to week 48 in the 19 participants with study-defined virological failure. Grade 3 and 4 adverse events were similarly distributed between the study arms. The most frequent grade 3 and 4 adverse events were weight loss (4/108 [4%]), insomnia (3/108 [3%]), and pneumonia (3/108 [3%]).
INTERPRETATION
Our findings suggest that twice-daily dolutegravir might be unnecessary in people with HIV-associated tuberculosis.
The drug-drug interaction between rifampicin and dolutegravir can be overcome by supplemental dolutegravir dosing, which is difficult to implement in high-burden settings. We aimed to test whether virological outcomes with standard-dose dolutegravir-based antiretroviral therapy (ART) are acceptable in people with HIV on rifampicin-based antituberculosis therapy.
METHODS
RADIANT-TB was a phase 2b, randomised, double-blind, non-comparative, placebo-controlled trial at a single site in Khayelitsha, Cape Town, South Africa. Participants were older than 18 years of age, with plasma HIV-1 RNA greater than 1000 copies per mL, CD4 count greater than 100 cells per μL, ART-naive or first-line ART interrupted, and on rifampicin-based antituberculosis therapy for less than 3 months. By use of permuted block (block size of 6) randomisation, participants were assigned (1:1) to receive either tenofovir disoproxil fumarate, lamivudine, and dolutegravir plus supplemental 50 mg dolutegravir 12 h later or tenofovir disoproxil fumarate, lamivudine, and dolutegravir plus matched placebo 12 h later. Participants received standard antituberculosis therapy (rifampicin, isoniazid, pyrazinamide, and ethambutol for the first 2 months followed by isoniazid and rifampicin for 4 months). The primary outcome was the proportion of participants with virological suppression (HIV-1 RNA <50 copies per mL) at week 24 analysed in the modified intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT03851588.
FINDINGS
Between Nov 28, 2019, and July 23, 2021, 108 participants (38 female, median age 35 years [IQR 31-40]) were randomly assigned to supplemental dolutegravir (n=53) or placebo (n=55). Median baseline CD4 count was 188 cells per μL (IQR 145-316) and median HIV-1 RNA was 5·2 log10 copies per mL (4·6-5·7). At week 24, 43 (83%, 95% CI 70-92) of 52 participants in the supplemental dolutegravir arm and 44 (83%, 95% CI 70-92) of 53 participants in the placebo arm had virological suppression. No treatment-emergent dolutegravir resistance mutations were detected up to week 48 in the 19 participants with study-defined virological failure. Grade 3 and 4 adverse events were similarly distributed between the study arms. The most frequent grade 3 and 4 adverse events were weight loss (4/108 [4%]), insomnia (3/108 [3%]), and pneumonia (3/108 [3%]).
INTERPRETATION
Our findings suggest that twice-daily dolutegravir might be unnecessary in people with HIV-associated tuberculosis.
Journal Article > CommentaryFull Text
Lancet HIV. 2016 February 2; Volume 3 (Issue 3); DOI:10.1016/S2352-3018(16)00002-3
Furin J, Isaakidis P
Lancet HIV. 2016 February 2; Volume 3 (Issue 3); DOI:10.1016/S2352-3018(16)00002-3