Low-Level Viremia among Adults Living with HIV on Dolutegravir-Based First-Line Antiretroviral Therapy Is a Predictor of Virological Failure in Botswana.

Autor: Bareng OT; Botswana Harvard Health Partnership, Gaborone 0000, Botswana.; Department of Medical Sciences, Faculty of Allied Health Professions, University of Botswana, Gaborone 0022, Botswana., Moyo S; Botswana Harvard Health Partnership, Gaborone 0000, Botswana.; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.; Department of Pathology, Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7935, South Africa.; School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa., Mudanga M; Department of Strategic Information, Botswana-University of Maryland School of Medicine Health Initiative, Gaborone 0022, Botswana., Sebina K; Department of Strategic Information, Botswana-University of Maryland School of Medicine Health Initiative, Gaborone 0022, Botswana., Koofhethile CK; Botswana Harvard Health Partnership, Gaborone 0000, Botswana.; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA., Choga WT; Botswana Harvard Health Partnership, Gaborone 0000, Botswana.; Department of Medical Sciences, Faculty of Allied Health Professions, University of Botswana, Gaborone 0022, Botswana., Moraka NO; Botswana Harvard Health Partnership, Gaborone 0000, Botswana.; Department of Medical Sciences, Faculty of Allied Health Professions, University of Botswana, Gaborone 0022, Botswana., Maruapula D; Botswana Harvard Health Partnership, Gaborone 0000, Botswana., Gobe I; Department of Medical Sciences, Faculty of Allied Health Professions, University of Botswana, Gaborone 0022, Botswana., Motswaledi MS; Department of Medical Sciences, Faculty of Allied Health Professions, University of Botswana, Gaborone 0022, Botswana., Musonda R; Botswana Harvard Health Partnership, Gaborone 0000, Botswana., Nkomo B; Botswana Ministry of Health, Gaborone 0038, Botswana., Ramaabya D; Botswana Ministry of Health, Gaborone 0038, Botswana., Chebani T; Botswana Ministry of Health, Gaborone 0038, Botswana., Makuruetsa P; Botswana Ministry of Health, Gaborone 0038, Botswana., Makhema J; Botswana Harvard Health Partnership, Gaborone 0000, Botswana.; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA., Shapiro R; Botswana Harvard Health Partnership, Gaborone 0000, Botswana.; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA., Lockman S; Botswana Harvard Health Partnership, Gaborone 0000, Botswana.; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.; Division of Infectious Diseases, Brigham & Women's Hospital, Boston, MA 02115, USA., Gaseitsiwe S; Botswana Harvard Health Partnership, Gaborone 0000, Botswana.; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
Jazyk: angličtina
Zdroj: Viruses [Viruses] 2024 May 01; Vol. 16 (5). Date of Electronic Publication: 2024 May 01.
DOI: 10.3390/v16050720
Abstrakt: We evaluated subsequent virologic outcomes in individuals experiencing low-level virem ia (LLV) on dolutegravir (DTG)-based first-line antiretroviral therapy (ART) in Botswana. We used a national dataset from 50,742 adults who initiated on DTG-based first-line ART from June 2016-December 2022. Individuals with at least two viral load (VL) measurements post three months on DTG-based first-line ART were evaluated for first and subsequent episodes of LLV (VL:51-999 copies/mL). LLV was sub-categorized as low-LLV (51-200 copies/mL), medium-LLV (201-400 copies/mL) and high-LLV (401-999 copies/mL). The study outcome was virologic failure (VF) (VL ≥ 1000 copies/mL): virologic non-suppression defined as single-VF and confirmed-VF defined as two-consecutive VF measurements after an initial VL < 1000 copies/mL. Cox regression analysis identified predictive factors of subsequent VF. The prevalence of LLV was only statistically different at timepoints >6-12 (2.8%) and >12-24 (3.9%) ( p -value < 0.01). LLV was strongly associated with both virologic non-suppression (adjusted hazards ratio [aHR] = 2.6; 95% CI: 2.2-3.3, p -value ≤ 0.001) and confirmed VF (aHR = 2.5; 95% CI: 2.4-2.7, p -value ≤ 0.001) compared to initially virally suppressed PLWH. High-LLV (HR = 3.3; 95% CI: 2.9-3.6) and persistent-LLV (HR = 6.6; 95% CI: 4.9-8.9) were associated with an increased hazard for virologic non-suppression than low-LLV and a single-LLV episode, respectively. In a national cohort of PLWH on DTG-based first-line ART, LLV > 400 copies/mL and persistent-LLV had a stronger association with VF. Frequent VL testing and adherence support are warranted for individuals with VL > 50 copies/mL.
Databáze: MEDLINE
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