Avaliação de exames laboratoriais de glicose, ureia, creatinina e marcadores de função hepática em pessoas iniciando terapia antirretroviral com dolutegravir ou efavirenz: estudo de coorte em Belo Horizonte-MG.

Abstract

The Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome is considered a global health problem. Antiretroviral therapy has significantly improved the quality of life for people living with HIV. The use of the drugs that make up the antiretroviral therapy for HIV is of paramount importance to reduce and maintain the viral load at undetectable levels, improving the quality of life of these people. However, these drugs are not free of adverse reactions and can cause metabolic changes and compromise the function of organs and systems. The objective of this study was to monitor the laboratory tests of blood glucose, urea, creatinine, total, direct and indirect bilirubin, aspartate amino transferase, alanine amino transferase, gamma glutamyl transferase and alkaline phosphatase in treatment-naïve individuals, initiating antiretroviral therapy with a regimen containing efavirenz or dolutegravir, seeking to contribute to the understanding of the safety of these drugs in use in the real world, followed for 72 weeks. Cohort study, with the follow-up of people living with HIV and initiating antiretroviral therapy, carried out in Belo Horizonte, Minas Gerais; with data collected between August 2015 and December 2018. 278 individuals were followed in the study of glucose, urea and creatinine tests and 234 individuals in the study of liver function tests. Among individuals who used dolutegravir, there was an increase in mean blood creatinine values at 24 (p<0.001) and 48 (p=0.012) weeks and glucose at 48 (p=0.017) and 72 weeks (p=0.019). In those who used efavirenz, there was an increase in creatinine levels at 48 weeks (p=0.007), glucose at 72 weeks (p=0.009) and urea at 48 weeks (p=0.023). In the multivariate analyses, being male (p=0.044) was a factor independently associated with an increase in creatinine. Tobacco use (p=0.006), illicit drug use (p=0.009) and schooling greater than or equal to 13 years of schooling, therefore, older age (p=0.038) were independently associated with changes in urea levels. The efavirenz regimen (OR = 8.20; 95% CI = 1.32-51.05; p=0.024) was independently associated with an increase in glucose concentration. The mean values for the results of the total and indirect bilirubin, aspartate amino transferase, alanine amino transferase and alkaline phosphatase tests reduced after 72 weeks of treatment for the two regimens studied. The mean value for direct bilirubin of those people using EFV increased at 72 weeks, when compared with the mean value at the beginning of the follow-up, being above the reference value. Before treatment, the mean results for gamma glutamyl transferase were above the reference value in both treatment groups. After 72 weeks of treatment with dolutegravir, the mean returned to baseline and, in the case of efavirenz, the mean remained high. Bonett's test results for variance and Dunnett's test for liver function tests showed no statistical differences at a significance level of 5%. This indicates that the two therapeutic regimens studied proved to be safe and did not cause changes in laboratory tests used as markers of liver function.