Toxicity of dolutegravir and evaluation of doravirine for alternative 1st line antiretroviral treatment in people living with HIV

The integrase inhibitors dolutegravir (DTG) is recommended by the World Health Organization (WHO) for 1st line antiretroviral therapy (ART) in people living with HIV (PLHIV) since 2018. Despite its high virologic efficacy, there is growing evidence showing massive weight gain and high incidence of metabolic disorders (obesity, type 2 diabetes) and hypertension under DTG, notably among women from sub-Saharan Africa (SSA) women, along with mental health and quality of life issues. The non-nucleoside reverse transcriptase inhibitor doravirine (DOR) is a potent novel ART, recommended in European and North-American guidelines, but not used so far in Southern countries despite interesting virological, safety and resistance profiles. In this context, the ELDORADO project will generate high-quality data on DTG-based ART toxicity and evaluate DOR as an alternative for 1st-line HIV-1 treatment in order to support national and international policymakers in updating national and international guidelines and practices aimed to improve patient outcomes and reduce disease burden of HIV in sub-Saharan Africa and worldwide. The project includes i) a randomized clinical trial assessing the non-inferiority of DOR-based ART as compared to DTG-based ART in terms of virologic efficacy, and its superiority in terms of key safety endpoints (obesity, diabetes, hypertension) in 610 PLHIV from diverse ethnic backgrounds across in SSA (Cameroon, Côte d’Ivoire, Mozambique), Brazil, Thailand, and France, ii) innovative assessments of organ lesions, iii) assessments of mental health and quality of life, iv) health impact and economics modelling based on the trial results as well as that of other trials (NAMSAL) and cohorts (IeDEA West Africa and Brazil). The project will also prioritize capacity building for junior investigators and community advisory board. The ELDORADO trial will be confounded in non-SSA countries by the ANRS|MIE (trial sponsor) and MSD, and benefits from support from the WHO.