Title

Improved viral load suppression with transition to pediatric dolutegravir among ART-experienced children in Kenya and Cote d’Ivoire

Presenter

Rose Masaba

Authors

R. Masaba¹, J. Kose^2,3, M. Kouadio⁴, S. Siamba¹, M. Ouma¹, J. Akuno², M. Mukaminega⁵, M. Gill⁶, A. Tiam⁵

Institutions

¹Elizabeth Glaser Pediatric AIDS Foundation, Research, Nairobi, Kenya, ²Elizabeth Glaser Pediatric AIDS Foundation, Program, Nairobi, Kenya, ³ErasmusMC, Department of Viroscience, Rotterdam University, Rotterdam, Netherlands, ⁴Elizabeth Glaser Pediatric AIDS Foundation, Research, Abidjan, Cote D'Ivoire, ⁵Elizabeth Glaser Pediatric AIDS Foundation, Program, Washington D.C., United States, ⁶Elizabeth Glaser Pediatric AIDS Foundation, Research, Washington D.C., United States

BACKGROUND: Access to safer and more efficacious and tolerable antiretroviral therapy (ART) is recommended for children and adolescents living with HIV (CALHIV). We evaluated viral load (VL) suppression at baseline and subsequent VL outcomes in a cohort of ART-experienced children who transitioned to dolutegravir (DTG)-based ART in Kenya and Cote d’Ivoire (CDI).
METHODS: This was an observational prospective cohort study of ART-experienced CALHIV who transitioned to DTG-based regimens. CALHIV 0-14 years, weighing 3-20 kilograms, were enrolled in 12 randomly selected facilities in CDI and Kenya, November 2021-May 2022 and followed for 12 months. Study facilities were randomly selected using probability proportional to size. Demographic data were collected, and VL testing were completed at baseline, 6 and 12 months. The national guidelines on use of antiretroviral drugs for treating and preventing HIV recommend VL monitoring at baseline, 6 and 12 months for CALHIV who are optimized on DTG-based regimen. Data were summarized using frequencies and proportions, as well as median and interquartile ranges.
RESULTS: Overall, 676 CALHIV initiated pediatric DTG with a median age of 9 (IQR: 6-12) years were enrolled into the study. A total of 355 (52.5%) were female, and 639 (83.3%) were living with biological parents. About three quarters (73.2%, 494/676) of the CALHIV were on a protease inhibitor-based regimen prior to DTG initiation. Median duration on ART regimen prior to DTG transition was 59 (IQR: 32, 84) months. Baseline VL uptake was 494/676 (83.3%). The uptake dropped to, 50% at 6 months and 74% at 12 months. Compared to a VL suppression of 80.6% [95% Confidence Interval (CI): 77.4%, 83.9%] at baseline, overall suppression was 87.7% [95% CI: 83.6%, 91.7%] at 6 months (p=0.013), and 89.6% [95% CI: 85.8%, 93.5%] at 12 months (p=0.002) post-DTG transition. There was no statistically significant difference in the viral load suppression at 6 and 12 months post-DTG transition (p=0.486).
CONCLUSIONS: While there remain challenges with viral load uptake and testing at time of transition to optimized regimen and follow up for CALHIV, there is improved VL suppression with DTG transition.