Predictors of Viral Non-Suppression among Patients Living with HIV under Dolutegravir in Bunia, Democratic Republic of Congo: A Prospective Cohort Study

Abstract

The Democratic Republic of the Congo adopted the integrase inhibitor dolutegravir (DTG) as part of its preferred first-line HIV treatment regimen in 2019. This study aimed to identify predictors of viral non-suppression among HIV-infected patients under a DTG-based regimen in the context of ongoing armed conflict since 2017 in the city of Bunia in the DRC. We conducted a cohort study of 468 patients living with HIV under DTG in all health facilities in Bunia. We calculated the proportion of participants with an HIV RNA of below 50 copies per milliliter. About three in four patients (72.8%) in this cohort had a viral load (VL) of <50 copies/mL after 6–12 months. After controlling for the effect of other covariates, the likelihood of having non-suppression remained significantly lower among the 25–34 age group and self-reported naïve patients with a baseline VL of ≥50 copies/mL. The likelihood of having non-suppression remained significantly higher among those who were at advanced stages of the disease, those with abnormal serum creatinine, those with high baseline HIV viremia over 1000 copies/mL, and the Sudanese ethnic group compared to the reference groups. This study suggests that we should better evaluate adherence, especially among adolescents and economically vulnerable populations, such as the Sudanese ethnic group in the city of Bunia. This suggests that an awareness of the potential effects of DTG and tenofovir is important for providers who take care of HIV-positive patients using antiretroviral therapy (ART), especially those with abnormal serum creatinine levels before starting treatment.

Opportunistic Infections in People Living with Human Immunodeficiency Virus Initiating Antiretroviral Therapy in Kinshasa, Democratic Republic of Congo

“…This predominant age group is recognized as the one in which the population is more sexually active. These results are similar to those published by various authors in Kinshasa who presented a similar average age in the populations of PLHIV and the dominant age group of 25 to 45 years [7][8][9][10][11][13][14][15][16][17][18].…”

“…Fifty-five (55) patients, or 47.0%, had a normal clinical condition; followed by 39 patients (33.3%) who had a good clinical state, 22 patients (18.8%) a bad clinical state and 1 patient (0.9%) a pre-moribund clinical state. These results have also been presented by various authors [13][14][15][16][17][18]. This late diagnosis of patients, generally in an advanced stage, has an impact on the management and prognosis of the follow-up of PLHIV.…”

“…The present study is a descriptive cross-sectional study to determine the profile of Opportunistic Infections (OI) among People Living with HIV (PLHIV) who starts ART in HIV Outpatient Treatment Centers (OTC) in Kinshasa. Sixteen (16) OTCs were included in the study because of their expertise in the care of PLHIV and their accessibility [12]. The patient inclusion period was from October 04, 2021 to February 15, 2022.…”

Factors Associated with HIV Virological Non-Suppression Among Adults Receiving Anti-Retroviral Therapy at Lira Regional Referral Hospital, Northern Uganda

“…According to the findings of a prospective cohort study conducted in Congo, the likelihood of having non-suppression remained significantly higher among those in advanced stages of the disease, those with abnormal serum creatinine, those with high baseline HIV viremia of over 1000 copies/mL, etc. (Buju et al, 2022). A cross-sectional study of children on ART at a major treatment center in Southern Ghana discovered a high rate of virological non-suppression at 38.4%, with factors associated with virological non-suppression including a previous history of TB treatment, female gender, severe CD4 immune suppression status at study recruitment, and being on a Nevarapine (NVP)-based regimen (Afrane et al, 2021).…”

Determinants of Survival of HIV Patients Receiving Dolutegravir: A Prospective Cohort Study in Conflict-Affected Bunia, Democratic Republic of Congo

“…Restricted access to healthcare services due to armed violence has been documented worldwide, such as in South America, where armed conflicts in Colombia have led to the forced displacement of millions of families [ 4 ]. In such insecure environments, the affected community may avoid visiting health facilities for fear of violence, rape, or even murder by the insurgents [ 5 , 6 ]. As a result, patients receiving ART may face challenges in following their routine ART programs and care schedules and experience a rebound in viral load (VL) and sometimes death [ 7 ].…”