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


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.