BACKGROUND: Prior to the introduction of newer antiretroviral regimens viral suppression among individuals on antiretroviral therapy was suboptimal. In 2018, the transition to a newer Dolutegravir (DTG)-based regimen commenced for individuals on ART in Nigeria. This study assesses long-term viral load outcomes of persons living with HIV (PLHIV) who transition to DTG-based regimen.
DESCRIPTION: This retrospective cohort study used routine program data from an electronic database of PLHIV (>15 years) receiving ART across 155 health facilities; with the support of PEPFAR through USAID in Akwa Ibom and Cross River State, Nigeria. Data for PLHIV who weighed above 30kg, were on first-line regimen, transitioned to DTG-based regimen as of June 2020, and had a viral load test done at transitioning and two (2) subsequent viral load tests at least 12-months apart, were abstracted. Outcomes analyzed include - Sustained viral suppression (i.e. three consecutive VL result <1000copies/ml), sustained viral unsuppression (i.e. three consecutive VL result =1000copies/ml), and viral rebound (i.e. any unsuppressed VL =1000copies/ml after an initial viral suppression) as of June 2022. Frequencies were used to summarize indices.
LESSONS LEARNED: A total of 40,980 [Female = 28,295; Male = 12,685] persons >15years were transitioned as of June 2020 with median age of 37 years [IQR 30-45years]. Viral suppression was 86.8% at baseline (35,568/40,980), and 98.5% at 24months post-transitioning. 84.2% of persons had sustained viral suppression throughout the monitoring period, while 2.5% experienced viral rebound and 0.3% sustained viral unsuppression (figure 1).Figure 1: Long-term viral load outcomes in a large ART cohort in Nigeria, June 2020-June 2022. (n-40,980)
CONCLUSIONS: Majority of clients transitioned to DTG-based regimen attained sustained viral suppression. However, there is a need to set-up adherence system to support PLHIV on DTG-based regimen because viral rebound and sustained viral unsuppression also occur.