Dolutegravir Sebagai Terapi Terbaru HIV/AIDS

Oleh :

dr. Hendra Gunawan SpPD

Dolutegravir (DTG), suatu Integrase strand transfer inhibitor (INSTI) merupakan salah satu terobosan baru dalam pengobatan HIV. Hal ini dikarenakan obat tersebut memiliki efikasi yang non-inferior dibandingkan obat yang saat ini beredar seperti efavirenz, efek samping, dan interaksi obat yang minimal.[1]

Departemen kesehatan pada Amerika Serikat dan Britania Raya telah merekomendasikan DTG sebagai terapi lini pertama dengan kombinasi dengan 2 macam obat Nucleoside Reverse Transcriptase Inhibitor (NRTI).[2,3]

Hingga saat ini, infeksi Human Immunodeficiency Virus (HIV) telah menjadi masalah kesehatan global. Namun, seiring dengan kemajuan pengobatan, infeksi HIV telah menjadi penyakit infeksi kronis yang dapat diobati dengan kombinasi obat Highly Active Antiretroviral Therapy (HAART). Walaupun kombinasi obat HAART sukses dapat menekan jumlah virus yang beredar dalam darah, namun risiko terjadinya efek samping pengobatan meningkat mengingat konsumsi obat tersebut dilakukan dalam jangka waktu yang lama.[4]

(Konten ini khusus untuk dokter. Registrasi untuk baca selengkapnya)

Referensi

1. Osterholzer DA, Goldman M. Dolutegravir: a next-generation integrase inhibitor for treatment of HIV infection. Clin Infect Dis. 2014;59(2):265-71
2. British HIV Association. British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015 (2016 interim update) London: British HIV Association; 2020 [cited 2020 November 3]. Available from: https://www.bhiva.org/file/RVYKzFwyxpgiI/treatment-guidelines-2016-interim-update.pdf.
3. DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV Washington: National Institute of Health; 2020 [cited 2020 November 3]. Available from: https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/AdultandAdolescentGL.pdf
4. Cruciani M, Parisi SG. Dolutegravir based antiretroviral therapy compared to other combined antiretroviral regimens for the treatment of HIV-infected naive patients: A systematic review and meta-analysis. PLoS One. 2019;14(9):e0222229
5. Kementerian Kesehatan Republik Indonesia. Surat Edaran tentang Rekomendasi Optimalisasi Panduan Obat Rejimen Anti Retroviral. Kementerian Kesehatan. 2020.
6. World Health Organization. WHO recommends dolutegravir as preferred HIV treatment option in all populations Mexico City: World Health Organization; 2019 [cited 2020 November 5]. Available from: https://www.who.int/news/item/22-07-2019-who-recommends-dolutegravir-as-preferred-hiv-treatment-option-in-all-populations.
7. Ciccullo A, Baldin G, Capetti A, Borghi V, Sterrantino G, Latini A, et al. Cohort profile: The Observational cohort for the study of DOlutegravir in Antiretroviral Combination REgimens (ODOACRE). BMJ Open. 2019;9(12):e029960.
8. Rutherford GW, Horvath H. Dolutegravir Plus Two Nucleoside Reverse Transcriptase Inhibitors versus Efavirenz Plus Two Nucleoside Reverse Transcriptase Inhibitors As Initial Antiretroviral Therapy for People with HIV: A Systematic Review. PLoS One. 2016;11(10):e0162775
9. boud M, Kaplan R, Lombaard J, Hidalgo JA, Mamedova E, Losso MH, et al. Dolutegravir versus ritonavir-boosted lopinavir both with dual nucleoside reverse transcriptase inhibitor therapy in adults with HIV-1 infection in whom first-line therapy has failed (DAWNING): an open-label, non-inferiority, phase 3b trial. The Lancet Infectious Diseases. 2019;19(3):253-64.
10. van Wyk J, Ajana F, Bisshop F, De Wit S, Osiyemi O, Portilla Sogorb J, et al. Efficacy and Safety of Switching to Dolutegravir/Lamivudine Fixed-Dose 2-Drug Regimen vs Continuing a Tenofovir Alafenamide–Based 3- or 4-Drug Regimen for Maintenance of Virologic Suppression in Adults Living With Human Immunodeficiency Virus Type 1: Phase 3, Randomized, Noninferiority TANGO Study. Clinical Infectious Diseases. 2020;71(8):1920-9.
11. Brehm TT, Franz M, Hüfner A, Hertling S, Schmiedel S, Degen O, et al. Safety and efficacy of elvitegravir, dolutegravir, and raltegravir in a real-world cohort of treatment-naïve and -experienced patients. Medicine. 2019;98(32):e16721-e
12. Zash R, Makhema J, Shapiro RL. Neural-Tube Defects with Dolutegravir Treatment from the Time of Conception. N Engl J Med. 2018;379(10):979-81.
13. Zash R, Holmes L, Diseko M, Jacobson DL, Brummel S, Mayondi G, et al. Neural-Tube Defects and Antiretroviral Treatment Regimens in Botswana. New England Journal of Medicine. 2019;381(9):827-40.
14. Kintu K, Malaba TR, Nakibuka J, Papamichael C, Colbers A, Byrne K, et al. Dolutegravir versus efavirenz in women starting HIV therapy in late pregnancy (DolPHIN-2): an open-label, randomised controlled trial. The Lancet HIV. 2020;7(5):e332-e9.
15. Eron JJ, Clotet B, Durant J, Katlama C, Kumar P, Lazzarin A, et al. Safety and efficacy of dolutegravir in treatment-experienced subjects with raltegravir-resistant HIV type 1 infection: 24-week results of the VIKING Study. J Infect Dis. 2013;207(5):740-8