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The fast and the continuous: dolutegravir-based antiretroviral therapy achieves impressive viral load suppression in CALHIV in the short- and long-term

Title
The fast and the continuous: dolutegravir-based antiretroviral therapy achieves impressive viral load suppression in CALHIV in the short- and long-term
Presenter
Jason Bacha
Authors
J. Bacha * (1,2,3), S. Dlamini (2,4), F. Anabwani (4), J. Gwimile (5), J.B. Kanywa (6), P.J. Elyanu (6), J. Farirai (7), M. Bvumbwe (8), M. Tsotako (9), T. Steffy (1,2,9), D. Nguywen (1,2,10), H. Haq (1,2)
Institutions
(1) Baylor College of Medicine, Pediatrics, Houston, United States, (2) Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children's Hospital, Houston, United States, (3) Baylor College of Medicine Children''s Foundation - Tanzania, Mbeya, Tanzania, The United Republic of, (4) Baylor College of Medicine Children''s Foundation - Eswatini, Mbabane, Eswatini, (5) Baylor College of Medicine Children''s Foundation - Tanzania, Mwanza, Tanzania, The United Republic of, (6) Baylor College of Medicine Children''s Foundation - Uganda, Kampala, Uganda, (7) Botswana-Baylor Children's Clinical Centre of Excellence Trust, Gabarone, Botswana, (8) Baylor College of Medicine Children''s Foundation - Malawi, Lilongwe, Malawi, (9) Baylor College of Medicine Children's Foundation - Lesotho, Maseru, Lesotho, (10) Baylor College of Medicine, Department of Education, Innovation, and Technology, Houston, United States

BACKGROUND: As dolutegravir (DTG)-based antiretroviral therapy (ART) is used as the preferred ART for children and adolescents living with HIV (CALHIV), questions remain about its short- and long-term effectiveness in the real-world. We describe longitudinal viral load suppression (VLS) trends of CALHIV using DTG in six African countries.
METHODS: Retrospective chart review from 2016 through 2021 analyzing clinical characteristics and VLS rates of CALHIV ages 0-19 years old prescribed DTG at clinics in Botswana, Eswatini, Lesotho, Malawi, Tanzania, and Uganda. VLS was defined as VL<1000 copies/mL. VL results were coded at 6 month intervals from DTG start date, with +/- 90 day buffer range. Initial VLS rate at 6 month post-DTG was used as the comparator for the longitudinal VLS rates and differences.
RESULTS: 11,799 CALHIV received DTG; 56.0% (6604/11799) were female and average age of 13.4 years (SD 4.0 yr). By study end, 93.7% (11059/11799) remained active in care, 4.7% (549/11799) transferred out, 1.2% (145/11799) were lost to follow up, and 0.4% (46/11799) died. 22,577 VL results were documented, ranging from 6 months to 60 months post-DTG and average follow up time post-DTG was 22.4 months (SD 12.4). Initial 6 month post-DTG VLS rate was 92.1%, similar across sexes (Females 91.6%, Males 92.7%) and ages (Figure 1). VLS rates were maintained without significant loss across the entire cohort, by sex and by age groups (Figure 2).

CONCLUSIONS: DTG rapidly achieved and consistently maintained VLS for years among CALHIV in real world settings. These findings support the widespread use of DTG in CALHIV.