Impact of Dolutegravir-based regimens on patient satisfaction and quality of life among people living with HIV: a systematic review and meta-analysis.

BACKGROUND

Despite the global scale up of dolutegravir (DTG)-based regimens as the preferred first-line therapy for persons living with HIV (PLHIV), no comprehensive evidence exists on its effect on patient-reported outcomes such as Quality of Life (QoL) and patient satisfaction (PS). We conducted a systematic review and meta-analysis to provide the first comprehensive quantitative synthesis of the effect of DTG-based regimens on QoL and PS among PLHIV.

METHOD: We conducted literature search on PubMed, Scopus, Embase and Cochrane Library databases for peer-reviewed, primary studies published from January 2015 to January 2025. Studies using validated tools to evaluate QoL and PS among PLHIV exposed to DTG were eligible. Standardised Mean Differences (SMD) were computed using DerSimonian-Laird random-effects model. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The study protocol was registered on PROSPERO (CRD42025643301).

RESULTS

Seventeen out of the 214 (n = 4064) identified studies met the inclusion criteria, with six contributing to the QoL meta-analysis and four to the PS meta-analysis. The pooled QoL estimate showed a small improvement favoring DTG-based regimens compared to other antiretroviral therapy (ART) though not statistically significant (SMD: 0.094, 95% CI: -0.034-0.223; p = 0.15; GRADE: Very Low). With the WHOQOL-HIV BREF tool subgroup, a positive directional effect was also observed (SMD: 0.09, 95% CI: -0.042-0.22, p = 0.18; I2 = 0.0%) compared to other ART, though not statistically significant. DTG-based regimens were associated with a statistically significant improvement in PS (SMD = 0.3; 95% CI: 0.2-0.4; p < 0.001; I2 = 10.7; GRADE: Low). Among studies that used the HIV Treatment Satisfaction Questionnaire to evaluate PS, the effect of DTG-based regimens was also statistically significant (SMD: 0.32, 95% CI: 0.2-0.45, p < 0.001; I2 = 34%).

CONCLUSION

This review identified a directional improvement in QoL and a statistically significant small improvement in PS among PLHIV on DTG-based regimens. Findings from this study were supported by low between-study heterogeneity. However, findings should be interpreted in the context of low and very low certainty of evidence for both outcomes. Additionally, results from this study are best characterized as hypothesis-generating and supportive of person-centered HIV care, underscoring the need for more well-designed trials to generate high-certainty evidence on patient-reported outcomes among PLHIV.

CLINICAL TRIAL NUMBER: Not applicable.