HIV viral suppression in children and adolescents who transitioned from ritonavir-boosted lopinavir- to dolutegravir-based antiretroviral therapy in Lesotho.

Abstract

Objectives: Children and adolescents living with HIV previously taking ritonavir-boosted lopinavir (LPV/r)-based antiretroviral therapy (ART) have been programmatically transitioned to dolutegravir (DTG)-based regimens in many country programs. We aimed to describe treatment outcomes following this transition in Lesotho, southern Africa.

Design: We analyzed routinely collected data from two open cohorts across 27 health facilities in Lesotho.

Methods: We included children and adolescents (<18 years at transition to DTG) who transitioned from first- or second-line ART consisting of LPV/r and 2 nucleoside reverse transcriptase inhibitors (NRTIs) to DTG and 2 NRTIs between July 2019 and July 2023. We report viral load (VL) data before transition, 12 months post-transition, and 24 months post-transition.

Results: Among 852 participants, 410 (48.1%) were female, the median age was 10.1 years (interquartile range [IQR] 7.6-13.0) and the median time on ART at transition was 8.1 years (IQR 5.6-11.1). Of 768 with a pre-transition VL, 617 (80.3%) had viral suppression (VS; <50 copies/mL), 85 (11.1%) had low-level viremia (LLV; 50-999 copies/mL), and 66 (8.6%) had a high VL (HVL; ≥1000 copies/mL). Among 822 with a 12-month post-transition VL, 721 (87.7%) had VS, 76 (9.2%) had LLV and 25 (3.0%) had HVL. Among 787 with 24-month post-transition VL, 686 (87.2%) had VS, 75 (9.5%) had LLV and 26 (3.3%) had HVL.

Conclusion: We observed improved and sustained VS among children and adolescents in routine care in Lesotho after programmatic transition to DTG-based ART, supporting continued scale-up of DTG in paediatric HIV programmes.