Viral suppression after transition from nonnucleoside reverse transcriptase inhibitor- to dolutegravir-based antiretroviral therapy: A prospective cohort study in Lesotho (DO-REAL study)

Abstract

Objectives: Since 2018, the World Health Organization has recommended dolutegravir (DTG)-containing antiretroviral therapy (ART) for most people living with HIV. Country programmes across Africa have subsequently transitioned from other, mostly nonnucleoside reverse transcriptase inhibitor (NNRTI)-based ART to DTG-based ART. This study aims to assess the virological impact of programmatic transitioning to DTG-based ART in Lesotho.

Methods: The prospective Dolutegravir in Real-Life in Lesotho (DO-REAL) cohort enrols people living with HIV initiating or transitioning to DTG-based ART in Lesotho. Here, we present data from participants who transitioned from NNRTI- to DTG-based ART between February and December 2020. Blood samples collected at transition and at 16 weeks' follow-up (window 8-32 weeks) were used for viral load (VL) and resistance testing.

Results: Among 1347 participants, follow-up data was available for 1225. The majority (60%) were female, median age at transition was 47 years [interquartile range (IQR): 38-56], and median (IQR) time since ART initiation was 5.9 (3.5-9.0) years. Among those with complete VL data, the rate of viral suppression to < 100 copies/mL was 1093/1116 (98%) before, 1073/1116 (96%) at, and 1098/1116 (98%) after transition. Even among those with a VL ≥ 100 copies/mL at transition, 42/44 (95%) achieved suppression to < 100 copies/mL at follow-up. Seven participants had a VL ≥ 1000 copies/mL at follow-up and did not harbour any integrase mutations associated with resistance to DTG.

Conclusions: The high levels of viral suppression observed are encouraging regarding virological outcomes upon programmatic transitioning from NNRTI- to DTG-based ART.

Keywords: HIV; Southern Africa; integrase inhibitors; observational study; viraemia.

Conflict of interest statement

TK reports advisory board membership fees from ViiV and Gilead for work outside of this study. NDL reports having received travel grants to attend IAS, AIDS and CROI conferences from Gilead Sciences Sarl. All other authors declare that they have no competing interests.

© 2021 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.

Figures

FIGURE 1

Viral load (VL) dynamics. The VL of the last measurement pre‐transition from an nonnucleoside reverse transcriptase inhibitor (NNRTI)‐ to a dolutegravir (DTG)‐based antiretroviral therapy (ART), the VL at transition, and the VL at follow‐up are shown among participants with VL data at all three time points (N = 1116). The median time between the last VL before transition and transition to DTG was 16 weeks [interquartile range (IQR): 12–24; range: 1–191]; the median time between transition and follow‐up was 16 (IQR: 16–18; range: 8–32). The colours of the nodes indicate the VL category at that time point; colour coding of the flows corresponds to the respective participant's VL pre‐transition [Colour figure can be viewed at wileyonlinelibrary.com]