Dolutegravir-Based Regimen Ensures High Virological Success despite Prior Exposure to Efavirenz-Based First-LINE ART in Cameroon: An Evidence of a Successful Transition Model

Abstract

To ensure optimal prescribing practices in the dolutegravir-era in Cameroon, we compared first-line virological response (VR) under tenofovir + lamivudine + dolutegravir (TLD) according to prior exposure to tenofovir + lamivudine + efavirenz (TLE). A facility-based survey was conducted among patients initiating antiretroviral therapy (ART) with TLD (I-TLD) versus those transitioning from TLE to TLD (T-TLD). HIV viral load was performed and unsuppressed participants (VL > 1000 copies/mL) had genotyping performed by Sanger sequencing. Of the 12,093 patients followed, 310 (mean-age: 41 ± 11 years; 52.26% female) complied with study criteria (171 I-TLD vs. 139 T-TLD). The median ART-duration was 14 (12–17) months among I-TLDs versus 28 (24.5–31) months among T-TLDs (15 (11–19) on TLE and 14 (9–15) on TLD), and 83.15% (148/178) were at WHO clinical stages I/II. The viral suppression rate (<1000 copies/mL) was 96.45%, with 97.08% among I-TLDs versus 95.68% among T-TLDs (p = 0.55). VR was similar in I-TLD versus T-TLD at <400 copies/mL (94.15% versus 94.42%) and age, gender, residence, ART-duration, and WHO stages were not associated with VR (p > 0.05). Genotyping was successful for 72.7% (8/11), with no major mutations to integrase inhibitors found. VR is optimal under first-line TLD after 14 months, even among TLE-exposed, thus confirming the effectiveness of transitioning from TLE to TLD in similar settings, supported by strong pharmacological potency and genetic barrier of dolutegravir.

Virological Non-Suppression, Non-Adherence and the Associated Factors Among People Living with HIV on Dolutegravir-Based Regimens: A Retrospective Cohort Study

“…Thus, our current sample size has achieved a better precision with a two-sided marginal error of 2.5% instead of the initial 5%. The current prevalence of 4.2% is comparable to other previous studies: 3.55% in Cameroon 20 and 6% in central Uganda. 22 However, our prevalence was lower than the prevalences reported in previous studies: 26.53% in Taiwan, 24 21% in a clinical trial conducted in Cameroon, 25 and 16% in a clinical trial in South Africa.…”

Risk of Emergent Dolutegravir Resistance Mutations In People Living With HIV: A Rapid Scoping Review

“…The three African cohorts included two cohorts containing 3117 individuals of whom approximately 95% were virologically suppressed on their first-line NNRTI-containing regimen [69,70] and one cohort of 139 individuals of whom just 10% were virologically suppressed [71]. In two cohorts, the proportions of those who were not suppressed at baseline and who developed VF were estimated to be 8% in one study and 10% in the other study [69,71]. GRT was performed in at least 20 individuals in the three cohorts.…”

Prevalence of Emergent Dolutegravir Resistance Mutations in People Living with HIV: A Rapid Scoping Review

“…Five cohort studies described the use of DTG plus two NRTIs in PLWH with a history of VF on an NNRTI-containing regimen ( Supplementary Table S3 ). Two were conducted in upper-income countries [ 65 , 66 ] and three in Sub-Saharan Africa [ 67 , 68 , 69 ]. The two upper-income country cohorts included 374 individuals with variable ART histories of whom approximately 70% were virologically suppressed prior to receiving DTG.…”

“…The three African cohorts included two cohorts containing 3117 individuals of whom approximately 95% were virologically suppressed on their first-line NNRTI-containing regimen [ 67 , 68 ] and one cohort of 139 individuals of whom just 10% were virologically suppressed [ 69 ]. In two cohorts, the proportions of those who were not suppressed at baseline and who developed VF were estimated to be 8% in one study and 10% in the other study [ 67 , 69 ]. GRT was performed in at least 20 individuals in the three cohorts.…”