Two-Year Outcomes of Treatment-Experienced Adults After Programmatic Transitioning to Dolutegravir: Longitudinal Data From the VICONEL Human Immunodeficiency Virus Cohort in Lesotho

Tschumi, Nadine; Lerotholi, Malebanye; Motaboli, Lipontso; Mokete, M.; Labhardt, Niklaus Daniel; Brown, Jennifer Anne

doi:10.1093/cid/ciad390

Cited by 5 publications

(4 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Compared with the paediatric data presented here, a study reporting 2-year outcomes of adult participants in VICONEL reported higher rates of viral suppression for both thresholds (50 copies/ml: 95.1%; 1000 copies/ml: 99.1%) [ 21 ], again highlighting the discrepancy between treatment outcomes of paediatric and adult populations. The observed association of pretransition viraemia with viraemia after transition to dolutegravir is consistent with studies conducted in adult populations [ 16 , 17 ], as are the reassuring viral load dynamics of participants with pretransition viraemia who mostly achieved viral suppression after transition [ 16 , 19 , 21 ]. Lastly, assessing adherence data of BCMCFL, we did not observe a significant association of nonadherence with viraemia at 24 months.…”

Section: Discussioncontrasting

confidence: 59%

See 1 more Smart Citation

HIV viral suppression in children and adolescents 2 years after transition to dolutegravir: a multicentre cohort study

Devendra,

Kohler,

Letsika

et al. 2024

Aids

Self Cite

View full text Add to dashboard Cite

Background: Treatment failure is common among children and adolescents with HIV. Antiretroviral therapy (ART) containing dolutegravir has recently been rolled out across Africa, though long-term real-world data in paediatric populations are lacking. Here, we report treatment outcomes among children and adolescents in Lesotho who transitioned from non-nucleoside reverse transcriptase inhibitor- (NNRTI-) to dolutegravir-based ART through two years’ follow-up. Methods: Data were derived from two open cohort studies in Lesotho. Children and adolescents aged < 18 years who transitioned from NNRTI- to dolutegravir-based ART at least 18 months before data closure were included. We report viral load results <12 months before, 12 (window: 6–17) months after, and 24 (window: 18–29) months after transition to dolutegravir. Associations of pre-transition demographic and clinical factors with 24-month viraemia were assessed through multivariable logistic regression. Results: Among 2126 included individuals, 1100 (51.7%) were female, median age at transition to dolutegravir was 14.0 years (interquartile range [IQR] 11.5–15.8), and median time taking ART at transition was 7.6 years (IQR 4.4–10.6). Among those with a viral load result at the respective time points, viral suppression to <50 copies/mL was achieved by 1635/1973 (82.9%) <12 months before, 1846/2012 (91.8%) 12 months after, and 1725/1904 (90.6%) 24 months after transition to dolutegravir. Pre-transition viraemia was associated with viraemia at 24 months, though >80% of individuals with pre-transition viraemia achieved resuppression to <50 copies/mL at 24 months. Conclusions: The proportion of children and adolescents with viral suppression increased after transition to dolutegravir, though further progress is needed to reach global targets.

show abstract

Section: Discussioncontrasting

confidence: 59%

“…Real-world outcomes among adults appear promising [ 16 – 21 ]. However, observational studies describing paediatric treatment outcomes after the rollout of dolutegravir are currently scarce [ 18 , 22 – 25 ].…”

Section: Introductionmentioning

confidence: 99%

HIV viral suppression in children and adolescents 2 years after transition to dolutegravir: a multicentre cohort study

Devendra,

Kohler,

Letsika

et al. 2024

Aids

Self Cite

View full text Add to dashboard Cite

show abstract

“…We found that previously described associations of lowlevel viraemia (50-999 copies/mL) with subsequent viraemia ≥1000 copies/mL hold true also in the era of dolutegravir, supporting the 2021 change in World Health Organization guidelines lowering the viral load threshold for clinical action [7,21]. Overall, short- [22] and long-term viral load outcomes after changing from NNRTI-to dolutegravir-based ART were encouraging, with >95% of adults and >90% of children and adolescents with non-missing data at 24 months having viral suppression to <50 copies/mL [6,8]. However, our recent findings raise important concerns regarding emergent resistance to dolutegravir: among the few participants with persistent and/or recurring viraemia including at least one viral load ≥500 copies/mL at least 18 months after starting dolutegravir, dolutegravir resistance was observed for approx.…”

Section: Review Of the Cohort's Broader Findings To Datementioning

confidence: 75%

“…The former is achieved in part through a dashboard for clinicians and automated reports flagging persons with incident or repeated viraemia to facilitate clinical followup. Scientific evidence is generated through analysis of routine data [4][5][6][7][8], as well as nested observational [9][10][11][12] and interventional studies [13].…”

Section: Cohort Descriptionmentioning

confidence: 99%

Cohort profile: the Viral load Cohort North-East Lesotho (VICONEL) from 2016 to 2022 – cohort description, test volumes, predictors of viraemia, and the road ahead

Brown,

Motaboli,

Lerotholi

et al. 2024

Preprint

Self Cite

View full text Add to dashboard Cite

Purpose: The prospective Viral load Cohort North-East Lesotho (VICONEL) aims to support clinical management and generate scientific evidence to inform HIV care. Specifically, VICONEL allows for monitoring of HIV treatment outcomes and health system performance, encompasses a biobank for further research with routinely collected blood plasma samples of consenting participants, and provides a valuable framework for nested observational and interventional studies. Participants: VICONEL captures routine viral load test results alongside associated demographic and treatment information among people in care for HIV in Lesotho, southern Africa. As of December 2022, it encompasses all viral load testing from 23 healthcare facilities in two districts of Lesotho. Findings to date: From January 2016 to December 2022, 114,838 viral load test results were available for 27,472 participants. At the time of the last viral load test, median age was 42 years (interquartile range [IQR]: 33-53); 17,324 (63%) were adult women, 9,273 (34%) adult men, and 870 (3%) children <15 years (age/sex missing for 5); and median time taking antiretroviral therapy (ART) was 6.0 years (IQR 3.0-9.2). Overall, the proportion of cohort participants with viral suppression to <1,000 copies/mL has continually exceeded 90% and has been above 95% since 2020; however, this proportion has consistently been lower among children. Sex, age category / ART regimen core agent (combined variable), time since ART initiation, and district were independently associated with viraemia. Future plans: VICONEL offers potential for i) further digitalisation and automation of results sharing at the client, facility, and district/national level, ii) integration of additional clinical and diagnostic data, including HIV comorbidities, and iii) embedding randomised trials.

show abstract

Emergence of Acquired Dolutegravir Resistance in Treatment-experienced People With HIV in Lesotho

Tschumi,

Lukau,

Tlali

et al. 2024

Clinical Infectious Diseases

View full text Add to dashboard Cite

Background Since 2019, the World Health Organization has recommended dolutegravir-based antiretroviral therapy (ART) as the preferred regimen for HIV management. Large-scale programmatic transitioning to dolutegravir-based ART was subsequently implemented across Africa, often in the absence of recent viral load testing and without access to genotypic resistance testing (GRT) in case of viremia. Methods This study assessed for emerging dolutegravir resistance in the routine care Viral Load Cohort North-East Lesotho (VICONEL). We included pediatric and adult participants who changed from non-nucleoside transcriptase inhibitor- (NNRTI-) to dolutegravir-based ART and had at least one viral load assessment before and after the change. We sequenced available samples of participants fulfilling the additional virological criteria of having two viraemic episodes while taking dolutegravir, thereof at least one viral load ≥500 copies/mL taken ≥18 months after changing to dolutegravir. Results Among 15’349 participants, 157 (1.0%) met the virological criteria and GRT was successful for 85 (0.6%). Among these 85, eight (9.4%) had dolutegravir resistance, with two (2.4%) and six (7.1%) predicted to have intermediate and high-level dolutegravir resistance, respectively. One participant had two, two had one, and five had zero active drugs in their regimen. A GRT from before the change to dolutegravir is available for five of these eight participants: four had zero and one had one active drug in their NNRTI-based regimen. Conclusions Nine percent of people with persistent or recurring HIV viremia ≥18 months after changing to dolutegravir-based ART had dolutegravir resistance. Detection and management of emerging dolutegravir resistance must be addressed across Africa.

show abstract

Two-Year Outcomes of Treatment-Experienced Adults After Programmatic Transitioning to Dolutegravir: Longitudinal Data From the VICONEL Human Immunodeficiency Virus Cohort in Lesotho

Cited by 5 publications

References 9 publications

HIV viral suppression in children and adolescents 2 years after transition to dolutegravir: a multicentre cohort study

HIV viral suppression in children and adolescents 2 years after transition to dolutegravir: a multicentre cohort study

Cohort profile: the Viral load Cohort North-East Lesotho (VICONEL) from 2016 to 2022 – cohort description, test volumes, predictors of viraemia, and the road ahead

Emergence of Acquired Dolutegravir Resistance in Treatment-experienced People With HIV in Lesotho

Contact Info

Product

Resources

About