Predictors of Viral Non-Suppression among Patients Living with HIV under Dolutegravir in Bunia, Democratic Republic of Congo: A Prospective Cohort Study.

Roger T Buju,Jean Marie N Kayembe,Pierre Z Akilimali,Gauthier K Mesia,Erick N Kamangu,Hippolyte N Situakibanza

doi:10.3390/ijerph19031085

Abstract

The Democratic Republic of the Congo adopted the integrase inhibitor dolutegravir (DTG) as part of its preferred first-line HIV treatment regimen in 2019. This study aimed to identify predictors of viral non-suppression among HIV-infected patients under a DTG-based regimen in the context of ongoing armed conflict since 2017 in the city of Bunia in the DRC. We conducted a cohort study of 468 patients living with HIV under DTG in all health facilities in Bunia. We calculated the proportion of participants with an HIV RNA of below 50 copies per milliliter. About three in four patients (72.8%) in this cohort had a viral load (VL) of <50 copies/mL after 6–12 months. After controlling for the effect of other covariates, the likelihood of having non-suppression remained significantly lower among the 25–34 age group and self-reported naïve patients with a baseline VL of ≥50 copies/mL. The likelihood of having non-suppression remained significantly higher among those who were at advanced stages of the disease, those with abnormal serum creatinine, those with high baseline HIV viremia over 1000 copies/mL, and the Sudanese ethnic group compared to the reference groups. This study suggests that we should better evaluate adherence, especially among adolescents and economically vulnerable populations, such as the Sudanese ethnic group in the city of Bunia. This suggests that an awareness of the potential effects of DTG and tenofovir is important for providers who take care of HIV-positive patients using antiretroviral therapy (ART), especially those with abnormal serum creatinine levels before starting treatment.

Highlights

This study aimed to identify predictors of viral failure among HIV-infected patients under a DTG-based regimen in the context of ongoing armed conflict since 2017 in the city of Bunia in the Ituri province, Democratic Republic of the Congo (DRC)
A previous study reporting viral suppression used a cut-off viral load (VL) of ≥1000 copies/mL (76.8% of the participants had achieved viral suppression) [20]; the non-suppression rate reported in this study (74%) is similar to the rate reported by Calmy et al [21]
Regarding predictors of non-suppression after initiating the DTG-based regimen, the current study revealed that patients with abnormal serum creatinine levels, those who were at an advanced stage of the disease, those with a high baseline HIV viremia over 1000 copies/mL, and the Sudanese ethnic group were found to have increased odds of non-suppression (VL ≥ 50 copies/mL) in this cohort study

Summary

Introduction

Even with the discovery of treatment, HIV infection remains a major public health problem in the world. Despite the proven efficacy of triple therapy with tenofovir, lamivudine, and dolutegravir (TDF + 3TC + DTG), predicting resistance and adverse events in patients on this regimen is a necessity to monitor virological failure (VF) [1,2], especially in resource-limited countries stricken by political and security instability. Antiretroviral therapy (ART) is aimed at achieving an undetectable viral load (VL) (

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