Tenofovir, Lamivudine, and Dolutegravir Among Rural Adolescents in Zimbabwe: A Cautionary Tale

Kouamou, Vinie; Machekano, Rhoderick; Mapangisana, Tichaona; Maposhere, Caroline; Munyati, Shungu; Mutsvangwa, Junior; Shamu, Tinei; McCarty, Kathy; Katzenstein, David; Manasa, Justen

doi:10.1089/aid.2021.0140

Cited by 6 publications

(11 citation statements)

References 17 publications

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“…On the other hand, clinical experience with DTG is growing in Africa and consistent findings from cohort studies among ART-naive and ART-experienced individuals are also being reported in real-world settings [21][22][23][24]. We recently showed that virological suppression increased from 76 to 95% following a switch to TLD among adolescents in rural Zimbabwe [25]. Similarly Brown et al [26] in 2022 showed that virological suppression (viral load <1000 copies/ml) of 99% was achieved at 4 months following the transition to DTG among individuals in Lesotho.…”

Section: Discussionsupporting

confidence: 55%

“…At baseline, participants had a normal BMI with a median (IQR) of 21.9 (19.1-26.0) kg/m 2 and 8% of the participants were obese with BMI at least 30 kg/m 2 . Female individuals had a significant higher median (IQR) BMI compared with male individuals (23 (20)(21)(22)(23)(24)(25)(26)(27) vs. 20 (19)(20)(21)(22)(23)(24), P ¼ 0.009, two-sample Wilcoxon rank-sum test).…”

Section: Resultsmentioning

confidence: 93%

“…Clinical outcomes of the participants at at least 24 weeks follow-up After a median (IQR) duration of 27 (25)(26)(27)(28)(29)(30) weeks on DTG, a total of 137 (79.7%) were still in care and followed up at the clinic, 10 (5.8%) participants were loss to followup, 10 (5.8%) transferred out and 15 (8.7%) died. The 15 participants who died had severe advanced HIV disease (baseline CD4 þ <100 cells/ml) at enrolment into the study.…”

Section: Resultsmentioning

confidence: 99%

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Virological, weight, and drug resistance outcomes among patients initiating a dolutegravir-based first-line antiretroviral therapy regimen in Zimbabwe

Kouamou,

Washaya,

Mapangisana

et al. 2024

Aids

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Objective: Dolutegravir (DTG)-based ART is being scaled up in Africa. However, clinical experience with DTG and patterns of HIV drug resistance (HIVDR) are sparse in Zimbabwe. We assessed virological, weight, and HIVDR outcomes among individuals initiating on a DTG-based ART. Design: We conducted a prospective cohort study among HIV infected adult (≥18 years old) individuals attending care at Parirenyatwa hospital, Harare, Zimbabwe between October 2021 and April 2023. Methods: Viral load and weight were assessed at both baseline and follow-up (≥24weeks) visits. HIVDR genotyping was performed by Sanger sequencing among participants with virological failure (VL≥1000 copies/ml) at follow up visit. Factors associated with weight gain were determined using logistic regression analysis on STATA 17.0. Results: 172 participants were enrolled in the study. The median (IQR) age was 39(29–48) years whilst the median (IQR) CD4 cell count and log10 VL at enrolment was 175(58–328) cells/mm3 and 5.41(4.80–5.74) respectively. After a median (IQR) duration of 27 (25–30) weeks on DTG, of the 131 participants with follow-up VL data available, 129 (98%) had VL<1000 copies/ml and among the 2 (2%) participants with VL≥1000 copies/ml, no emergent HIVDR was detected. We observed a significant increase in weight among the participants. The average weight gain was 5.25 kgs (p < 0.0001). Baseline CD4 cell count ≥200 cells/mm3 was significantly associated with at a smaller weight gain (OR = 0.26; 95% CI: 0.12–0.58, p = 0.001). Conclusion: We found high virological suppression and an increased weight among people initiating on DTG in a resource-limited setting. Encouragingly, HIVDR to DTG remains rare.

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Section: Discussionsupporting

confidence: 55%

Section: Resultsmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

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Virological, weight, and drug resistance outcomes among patients initiating a dolutegravir-based first-line antiretroviral therapy regimen in Zimbabwe

Kouamou,

Washaya,

Mapangisana

et al. 2024

Aids

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“…Patients who exhibit virological failure and potential medication resistance may still be moved to therapy with TLD despite the growing accessibility of viral load (VL) testing. 23 …”

Section: Discussionmentioning

confidence: 99%

Drug Use Evaluation of Tenofovir/Lamivudine/Dolutegravir (TLD) Fixed-Dose Combination for Initiation and Transition Among HIV-Infected Individuals Attending Lumame Primary Hospital, North West Ethiopia

Tegegne,

Alehegn,

Kassahun

2024

IPRP

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Background A key strategy for quality improvement is drug use evaluation, which looks at the safe, appropriate use of medication principles. Tenofovir/Lamivudine/Dolutegravir (TLD-FDC) usage has not yet been sufficiently examined in published literature. The purpose of this study was to assess how TLD were used by HIV-positive patients Using WHO drug use evaluation standards in Lumame Primary Hospital, North West Ethiopia. Methods Using WHO drug use evaluation standards, a retrospective study design was used to evaluate the appropriateness of TLD use. Systematic random sampling was utilized to gather patient medical records containing TLD. Accordingly, 100 records that met the inclusion criteria were selected and reviewed between April 1 and 15, 2021. Five criteria, namely, indication, dose, contraindication, drug interaction, and TLD safety monitoring were used to evaluate the appropriateness of TLD utilization. Results 80% of patients were transited to TLD from other regimens. The median time on TLD was found to be 13 months with 9 months to 18 months IQR. The latest CD4 count as well as CD4 count at the initiation or transition of TLD was not done for 75% and 89% of the patients, respectively. 3/4 (75%) of the patients were found to have a scheduled medication refill history. TLD dosing, indications, and contraindications were found to be 100% appropriate. No, TLD safety monitoring tests were done for 21% of the patients in this study. However, viral load, liver/kidney function, and serum creatinine tests were done for 77% (95% CI: 74%–79%), 5% (95% CI: 2%–8%), and 14% (95% CI: 11%–17%) of the patients, respectively. More over, In 93% (95% CI: 91%–95%) of the patients, the TLD interaction was appropriate; in 7%, it was not. All recording, documenting, and reporting technologies were available and used efficiently, except for the Electronic Dispensing Tool. Conclusion Generally, good adherence to national and WHO guidelines was obtained regarding dose, indication, and contraindications. However, improvement in safety monitoring tests and CPT utilization is recommended. Drug interactions satisfied the majority of the criteria’s threshold, while certain standards were not followed.

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“…Previous Zimbabwe studies show high pretreatment and acquired HIVDR against non-nucleoside reverse transcriptase inhibitors. Dolutegravir is the preferred first-line regimen but enhanced HIVDR surveillance is crucial to preserve its efficacy ( 12 , 21 , 22 ). In this article, we discuss the need, benefits, and strategies for strengthening and enhancing HIVDR surveillance in Zimbabwe.…”

Section: Introductionmentioning

confidence: 99%

Strengthening and enhancing national antiretroviral drug resistance surveillance in Zimbabwe—A country that has reached UNAIDS 95-95-95 amongst adults

Dzinamarira,

Moyo,

Moyo

et al. 2024

Front. Public Health

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Tenofovir, Lamivudine, and Dolutegravir Among Rural Adolescents in Zimbabwe: A Cautionary Tale

Cited by 6 publications

References 17 publications

Virological, weight, and drug resistance outcomes among patients initiating a dolutegravir-based first-line antiretroviral therapy regimen in Zimbabwe

Virological, weight, and drug resistance outcomes among patients initiating a dolutegravir-based first-line antiretroviral therapy regimen in Zimbabwe

Drug Use Evaluation of Tenofovir/Lamivudine/Dolutegravir (TLD) Fixed-Dose Combination for Initiation and Transition Among HIV-Infected Individuals Attending Lumame Primary Hospital, North West Ethiopia

Strengthening and enhancing national antiretroviral drug resistance surveillance in Zimbabwe—A country that has reached UNAIDS 95-95-95 amongst adults

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