Takemi Program in International Health
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Longitudinal Outcomes of Dolutegravir-Based Antiretroviral Therapy in People Living with HIV:
Retrospective Analysis from a Nationally Representative Nigerian Cohort
Adam Abdullahi MRes, PhD,1,2 Martin Edun,3 Ravindra K. Gupta,2 and Phyllis J. Kanki 4
¹ Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA
² Department of Medicine, University of Cambridge, UK
³ Institute of Human Virology, Nigeria
⁴ Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA
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Introduction
Globally, 39 million people were living with HIV at the end of 2022, with three-quarters of these individuals living across the sub-Saharan African region.1 Since 2018, millions of people living with HIV started transitioning from previous non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based antiretroviral therapy regimens to dolutegravir (DTG)-based ART.2 DTG is an optimal drug of choice for first-line ART due to its higher potency, genetic barrier to resistance, and shorter time to suppression.
With the aim of ending the AIDS epidemic by 2030, one of the UNAIDS 95-95-95 agenda aims at ensuring virological suppression of PLWH accessing treatment. Therefore, it is important to assess progress, especially in the context of newer treatment strategies.
Objectives
- Assess virological suppression rates of PLWH transitioning to DTG-based ART after 24 months of transition in Abuja, Nigeria.
- Characterize the determinants of virological suppression using regression analysis.
Methods
Design
Retrospective population-level data analysis from 2018- 2019 from 33,982 participants.
Analysis
Evaluation of virological suppression rates (viral load ≤50 copies/mL) at 12M and 24M following DTG transition and evaluation of determinants of suppression outcome using Poisson regression analysis.
Setting
Nigeria (Electronic data abstraction in Abuja, Nigeria).
Participants
Adult PLWH (≥15 years) transitioning to DTG-based regimen.
Outcome Measure
Virological suppression after 12 and 24 months of participants followed for up to two years.
Results
Table 1: Characteristics of participants initiating DTG-based ART
Key Findings: Virological Suppression Rates
Figure 1: Virological suppression rates after routine switching to DTG-based first-line ART.
Key Takeaways
Understanding how the pandemic affected TB control efforts can help policymakers develop strategies to mitigate the impact of future pandemics.
With the aim of ending the AIDS epidemic by 2030, one of the UNAIDS 95-95-95 agenda aims at ensuring virological suppression of PLWH accessing treatment. Therefore, it is important to assess progress, especially in the context of newer treatment strategies.
- 27,608/33,982 (81.2%) had viral load data available at 12M and 25,990/33,982 (76.4%) at 24M.
- Most participants were female, 21,930/33,982 (65%), with a median age of 38 years (IQR: 32-45).
- Virological suppression rates at 12M were 22,006/27,608 (79.7%), and 24M were 21,320/25,990 (82%).
- Higher rates of suppression were observed in switchers relative to starters at 12M and 24M.
Discussion and Recommendations
- In the DTG era, evidence suggests robust virological response following transition with overall, suppression rates ≈ 80%.
- Low level viraemia was common and to a lesser extent, virological non-suppression; overall higher frequency in DTG starters relative to switchers.
- Sub-optimal retention rates in care with likely population level impact of continuous transmission.
- Our full results support the continued scale-up of DTG as drug of choice in Nigeria with virological monitoring, drug resistance and adherence support to improve retention in care.
References
- World Health Organization, “Update of recommendations on first- and second-line antiretroviral regimens,” 2019.
- UNAIDS, “FACT SHEET – GLOBAL AIDS UPDATE 2019,” 2019.
Acknowledgements
Takemi Program in International Health and Cambridge-Africa Program