Dolutegravirbased Antiretroviral Therapy Achieves Impressive Viral Load Suppression in CALHIV in the Short and LongTerm Jason M Bacha 123 Sandile Dlamini 24 Florence Anabwani 4 Judith Gwimile ID: 1038894
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1. The Fast and The Continuous: Dolutegravir-based Antiretroviral Therapy Achieves Impressive Viral Load Suppression in CALHIV in the Short- and Long-Term Jason M. Bacha1,2,3, Sandile Dlamini2,4, Florence Anabwani4, Judith Gwimile5, Jacqueline Balungi Kanywa6, Peter James Elyanu6, John Farirai7, Menard Bvumbwe8, Mabene Tsotako9, Teresa Steffy1,2,9, Diane Nguyen1,2,10, Heather Haq1,2
2. DisclosuresI have no conflicts of interest to declare
3. BackgroundDolutegravir (DTG)-based antiretroviral therapy (ART) is the preferred ART for children and adolescents living with HIV (CALHIV) worldwideQuestions remain about real-world short- and long-term effectivenessWe describe characteristics, clinical outcomes, and longitudinal viral load suppression (VLS) trends of CALHIV using DTG at BIPAI Network Centres of Excellences (COEs) in six countries in East and Southern Africa
4. MethodsRetrospective review from BIPAI EMR Sites: 7 sites in 6 countries Dates of analysis: Jan 2016 - Dec 2021 (6yr)Available formulations: TLD and DTG 50mg tabsHIV viral load (VL) suppression was defined as VL<1000 copies/mLAll CALHIV (0-19.99yo) enrolled in care at a Baylor COE and prescribed DTG-based ARTStata 17 used for data analysisVL results coded at 6-month intervals (+/- 90-day buffer range for VL test)VL suppression (VLS) rate at 6 months post-DTG was used as the comparator VLS rateMBEYAMWANZAMap of BIPAI Network Countries included in analysis
5. Results – Clinical Characteristics11,799 CALHIV received DTG
6. Results - Outcomes21,077 person-years of follow upMean follow up time post-DTG of 22.4 months (SD 12.4)22,577 documented VL results Ranged 6 to 60 months post-DTG6-month post-DTG VLS rate for cohort of 92.4% (8120/8816)6-month post-DTG VLS rate for ART naïve of 93.1% (1793/1925)
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12. Results – Comparison of change in VLS over time**2 to 2.5 years post DTG reflects peak COVID-19 pandemic time for majority of sites and patients
13. Snapshot of Single Drug Substitutions (SDS)3738 CALHIV with a SDS using DTGCohort of SDS with DTGPre-DTG VLS6mo VLS post-SDS12 mo VLS post-SDS18mo VLS post SDS24mo VLS post SDSAll CALHIV SDS94.5% (3614/3824)92.7% (2667/2878) p=<0.0193.9% (1557/1658) p=0.37893.1% (740/795) p=0.12291.9% (341/371) p=0.040ABC-based SDS93.6% (2076/2217)92.1% (1408/1529) p=0.07792.6% (737/796) p=0.33291.0% (322/354) p=0.07090.2% (138/153) p-0.101AZT-based SDS96.4% (486/504)94.8% (421/444) p=0.22897.1% (301/311) p=0.58996.7% (232/240) p=0.85896.2% (76/79) p=0.930TDF-based SDS95.4% (1052/1103)92.6% (838/905) p=<0.0194.0% (518/551) p=0.221292.5% (186/201) p=0.08491.4% (127/139) p=0.051
14. Snapshot of Single Drug Substitutions (SDS)3738 CALHIV with a SDS using DTGCohort of SDS with DTGPre-DTG VLS6mo VLS post-SDS12mo VLS post-SDS18mo VLS post SDS24mo VLS post SDSAll CALHIV SDS94.5%-1.8%[-3.0%, -0.6%]-0.6%[-2.0%, 0.7%]-1.4%[-3.5%, 0.3%]-2.6%[-5.9%, -0.1%]ABC-based SDS93.6%-1.5%[-3.2%, 0.2%]-1.0%[-3.2%, 1.0%]-2.6%[-6.2%, 0.2%]-3.4%[-9.2%, 0.5%]AZT-based SDS96.4%-1.6%[-4.4%, 1.0%]0.7%[-2.1%, 3.1%]0.3%[-2.9%, 3.1%]0.2%[-3.0%, 7.1%]TDF-based SDS95.4%-2.8%[-5.0%, -0.7%]-1.4%[-3.9%, 0.8%]-2.9%[-7.5%, 0.3%]-4.0%[-10.3%, 0.0%]
15. Snapshot of Single Drug Substitutions (SDS)~80% additive VLS among previously unsuppressed (n=210) VLS rate after SDS with DTG by chronological VL test among previously unsuppressed cohortCohort of CALHIV (n, %)First post-DTG VLSecond post-DTG VLThird post-DTG VLFourth post-DTG VLAll CALHIV (n=210, 5.5%)79.9% (115/144)78.8% (67/85)79.1% (34/43)80.0% (16/20)ABC-based SDS (n=141, 6.4%)80.0% (76/95)79.3% (46/58)76.7% (23/30)78.6% (11/14)AZT-based SDS (n=18, 3.6%)83.3% (10/12)100% (8/8)75.0% (3/4)100% (1/1)TDF-based SDS (n-51, 4.6%)78.4% (29/37)68.4% (13/19)88.9% (8/9)80.0% (4/5)
16. DiscussionDTG rapidly achieved and consistently maintained VLS for years among CALHIV in clinical settings in East and Southern Africa.Female and young adolescent remain key populations for focused efforts to achieve VLSThe 2-3 year post-DTG period may be a time period of interestSDS with DTG was a viable strategy in our cohortNext steps include additional analysis into sub-cohorts of interest and potential drivers of high and low VLS rates among CALHIVPsychosocial and adherence factors, MMD, genotyping (INSTI)These findings add further support for the widespread rollout of DTG in CALHIV globally.
17. Companion e-poster EPB198 (PIDTG cohort)
18. Thank you! (bacha@bcm.edu)