Dolutegravir-based ART yields strong virologic response in children living with HIV

Treatment with paediatric dolutegravir-containing antiretroviral therapy (ART) results in robust virologic response among children living with HIV (CLHIV), reports a Cameroon study.

A total of 318 CLHIV (median age 8 years, 50.9 percent girls) attending the Chantal BIYA Foundation’s Mother and Child Centre in Yaoundé-Cameroon participated in this facility-based longitudinal study from November 2022 through April 2023.

The authors evaluated plasma viral load (PVL) and HIV drug resistance. Virologic failure was defined as two consecutive PVL ≥1,000 copies/mL under active adherence counselling or support.

Of the participants, 299 (94.03 percent) received paediatric dolutegravir-based ART (mean ART duration 5.6 years). Thirty-seven (11.6 percent) children were virally unsuppressed (PVL ≥1,000 copies/mL) at enrolment, with greater odds among those from rural areas (p=0.018) and those reporting poor adherence (p<0.001).

Following active adherence counselling and support, thirty (81.1 percent) of the 37 children underwent resampling after 1 month and three remained virally unsuppressed, representing <1 percent (3/311) with virologic failure overall.

HIV drug resistance mutations were observed in <1 percent (2/311) of children with virologic failure (L74V [1/3], K103N [1/3], M184V [2/3], P225H [1/3]).

“Virologic failure in CLHIV remains challenging in sub-Saharan Africa, reaching alarming rates in Cameroon,” the authors said.

“Combining robust ART regimens with active adherence support can advance sustained progress towards HIV elimination in children by 2030 in sub-Saharan Africa,” they noted.