Journal Article

HIV viral suppression at different thresholds and duration of treatment in the dolutegravir treatment era in Sierra Leone: a nationwide survey

Song, Jin-Wen, Jalloh, Abdulai Tejan, Barrie, Umu, Liu, Ming, Guan, Qun, Sun, Wei, Lakoh, Sulaiman, Jiba, Darlinda F., Tamba, Francis K., Yang, Guang, Yendewa, George A., Zhao, Rongtao, Kamara, Matilda N., Wang, Ligui

2023

Overview

Introduction Viral load assessment for people living with HIV is key for monitoring treatment and achieving the 95-95-95. In this study, we aimed to assess the degree of viral suppression at different thresholds and treatment duration after the introduction of dolutegravir-based therapy in ten public hospitals in Sierra Leone. Methods We used a cross-sectional study design to recruits patients aged 18 years or older between August 2022 and January 2023. Statistical analyses were performed using R-software. Logistic regression was used to assess factors independently associated with viral suppression. The level of significance was set at P < 0.05. Results Of the 2,253 patients recruited, 1,720 (76%) were women and 1,705 (76%) were receiving a fixed dose combination of tenofovir, lamivudine and dolutegravir. The median age and duration of anti-retroviral therapy (ART) was 36.0 (IQR, 28.0–45.0) years and 40.9 (IQR, 14.4–79.6) months, respectively. Using a threshold of HIV RNA < 1000 copies/mL, 1,715 (88.4%) patients on ART for more than 6 months were virally suppressed. Viral suppression rates were higher with dolutegravir-based (1,277, 89.5%) than efavirenz-based (418, 86.2%) ART. HIV RNA was < 200 copies/mL in 1,643 (84.6%) patients or < 50 copies/mL in 1,487 (76.6%) patients or between 50 and 999 copies/mL in 228 (11.7%) patients. Viral suppression rates at different ART durations (months) were as follows: 84.2% (≤ 3), 88.8% (4–6), 90.9% (6–12), and 88.1% (> 12). Viral suppression rates were higher for patients aged 40 or older (40–50 years: aOR 2.05, 95%CI 1.41–3.04, P < 0.01; 50–60 years: aOR 2.51, 95%CI 1.53–4.35, P < 0.01; >60 years: aOR 2.69, 95%CI 1.28–6.63, P = 0.02). Men had 49% lower odds of viral suppression than women (aOR 0.50, 95% CI 0.38–0.67, P < 0.01). Conclusion We report a viral suppression rate of 88.4% among patients on treatment for at least 6 months, with higher rate of suppression with dolutegravir than efavirenz. Factors associated with virological suppression were age and gender, emphasizing the need for innovative differentiated ART delivery models to optimize viral suppression and achieve the 95% target.

• Publisher: BioMed Central,Springer Nature B.V,BMC
• Subject: Acquired immune deficiency syndrome / AIDS / Anti-HIV Agents - therapeutic use / antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Benzoxazines - adverse effects / Biomedical and Life Sciences / Biomedicine / Cross-Sectional Studies / Dolutegravir / Duration of Therapy / Efavirenz / Female / gender / Health facilities / HIV / HIV Infections - drug therapy / Hospitals / Human immunodeficiency virus / Humans / Laboratories / Lamivudine / Low-level viremia / Male / Maternal & child health / Mutation / national surveys / Oxazines - therapeutic use / Patients / Primary care / regression analysis / RNA / Sierra Leone / Statistical analysis / Tenofovir / therapeutics / Thermal cycling / Viral Load / Viral suppression / Viral suppression rate / Virology