Amalia Girón-Callejas, Rolando Lorenzana, Michael Pickles, Seth Inzaule, Michael R Jordan, Sheilee Diaz, Charlotte Vrinten
{"title":"在低收入和中等收入国家中，接受世卫组织推荐的以多曲地韦为基础的一线抗逆转录病毒治疗的成年人中，艾滋病毒的抑制程度很高：对规划证据的系统回顾和荟萃分析。","authors":"Amalia Girón-Callejas, Rolando Lorenzana, Michael Pickles, Seth Inzaule, Michael R Jordan, Sheilee Diaz, Charlotte Vrinten","doi":"10.1186/s12981-025-00788-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This systematic review and meta-analysis assessed viral suppression among adults receiving WHO-recommended first-line dolutegravir-based ART in programmatic settings in low- and middle-income countries (LMICs).</p><p><strong>Methods: </strong>A systematic search of Ovid MEDLINE, Embase, and major HIV conferences (IAS, AIDS, and CROI) from January 2019 to September 2024 identified cohort and cross-sectional studies reporting viral suppression among adults receiving WHO-recommended first-line dolutegravir-based ART in LMICs. Studies with follow-ups ≤ 4 months or using non-WHO-recommended regimens were excluded. Pooled estimates were calculated using random-effects meta-analysis. Sensitivity analyses excluded outliers. Subgroup analyses distinguished adults initiating versus transitioning to dolutegravir-based ART. Both on-treatment and intention-to-treat outcomes were assessed.</p><p><strong>Results: </strong>Twenty-two studies (n = 47 to 50,742) from 13 countries were included. On-treatment pooled viral suppression was 95% (95% CI: 91-97%, I²= 96%) at six months, 96% (94-98%, I² = 97%) at 12 months, and 98% (96-99%, I² = 94%) at 24 months. Sensitivity analysis removing outliers decreased heterogeneity and slightly lowered the 6‑month estimate (to 94%), with negligible change at 12 months. At 6 months, viral suppression was higher in those transitioning than initiating ART (98% vs. 94%, p < 0.01), with similar rates at 12 months (97%, p = 0.67). The pooled intention-to-treat 12-month viral suppression rate was 89% (82-93%, I² = 95%), with no significant difference by ART status (initiating 86% vs. transitioning 91%, p = 0.44).</p><p><strong>Conclusion: </strong>Adults retained in care receiving WHO-recommended first-line dolutegravir-based ART achieved viral suppression rates of ≥ 95% up to two years. These findings align with the UNAIDS 95% suppression target and reinforce the role of dolutegravir-based regimens in ending HIV as a public health threat.</p><p><strong>Trial registration: </strong>CRD42024557769.</p>","PeriodicalId":7503,"journal":{"name":"AIDS Research and Therapy","volume":"22 1","pages":"91"},"PeriodicalIF":2.5000,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465354/pdf/","citationCount":"0","resultStr":"{\"title\":\"High HIV viral suppression among adults receiving WHO-recommended first-line dolutegravir-based antiretroviral therapy in low- and middle-income countries: a systematic review and meta-analysis of programmatic evidence.\",\"authors\":\"Amalia Girón-Callejas, Rolando Lorenzana, Michael Pickles, Seth Inzaule, Michael R Jordan, Sheilee Diaz, Charlotte Vrinten\",\"doi\":\"10.1186/s12981-025-00788-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>This systematic review and meta-analysis assessed viral suppression among adults receiving WHO-recommended first-line dolutegravir-based ART in programmatic settings in low- and middle-income countries (LMICs).</p><p><strong>Methods: </strong>A systematic search of Ovid MEDLINE, Embase, and major HIV conferences (IAS, AIDS, and CROI) from January 2019 to September 2024 identified cohort and cross-sectional studies reporting viral suppression among adults receiving WHO-recommended first-line dolutegravir-based ART in LMICs. Studies with follow-ups ≤ 4 months or using non-WHO-recommended regimens were excluded. Pooled estimates were calculated using random-effects meta-analysis. Sensitivity analyses excluded outliers. Subgroup analyses distinguished adults initiating versus transitioning to dolutegravir-based ART. Both on-treatment and intention-to-treat outcomes were assessed.</p><p><strong>Results: </strong>Twenty-two studies (n = 47 to 50,742) from 13 countries were included. On-treatment pooled viral suppression was 95% (95% CI: 91-97%, I²= 96%) at six months, 96% (94-98%, I² = 97%) at 12 months, and 98% (96-99%, I² = 94%) at 24 months. Sensitivity analysis removing outliers decreased heterogeneity and slightly lowered the 6‑month estimate (to 94%), with negligible change at 12 months. At 6 months, viral suppression was higher in those transitioning than initiating ART (98% vs. 94%, p < 0.01), with similar rates at 12 months (97%, p = 0.67). The pooled intention-to-treat 12-month viral suppression rate was 89% (82-93%, I² = 95%), with no significant difference by ART status (initiating 86% vs. transitioning 91%, p = 0.44).</p><p><strong>Conclusion: </strong>Adults retained in care receiving WHO-recommended first-line dolutegravir-based ART achieved viral suppression rates of ≥ 95% up to two years. These findings align with the UNAIDS 95% suppression target and reinforce the role of dolutegravir-based regimens in ending HIV as a public health threat.</p><p><strong>Trial registration: </strong>CRD42024557769.</p>\",\"PeriodicalId\":7503,\"journal\":{\"name\":\"AIDS Research and Therapy\",\"volume\":\"22 1\",\"pages\":\"91\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-09-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465354/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"AIDS Research and Therapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12981-025-00788-8\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"AIDS Research and Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12981-025-00788-8","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
High HIV viral suppression among adults receiving WHO-recommended first-line dolutegravir-based antiretroviral therapy in low- and middle-income countries: a systematic review and meta-analysis of programmatic evidence.
Background: This systematic review and meta-analysis assessed viral suppression among adults receiving WHO-recommended first-line dolutegravir-based ART in programmatic settings in low- and middle-income countries (LMICs).
Methods: A systematic search of Ovid MEDLINE, Embase, and major HIV conferences (IAS, AIDS, and CROI) from January 2019 to September 2024 identified cohort and cross-sectional studies reporting viral suppression among adults receiving WHO-recommended first-line dolutegravir-based ART in LMICs. Studies with follow-ups ≤ 4 months or using non-WHO-recommended regimens were excluded. Pooled estimates were calculated using random-effects meta-analysis. Sensitivity analyses excluded outliers. Subgroup analyses distinguished adults initiating versus transitioning to dolutegravir-based ART. Both on-treatment and intention-to-treat outcomes were assessed.
Results: Twenty-two studies (n = 47 to 50,742) from 13 countries were included. On-treatment pooled viral suppression was 95% (95% CI: 91-97%, I²= 96%) at six months, 96% (94-98%, I² = 97%) at 12 months, and 98% (96-99%, I² = 94%) at 24 months. Sensitivity analysis removing outliers decreased heterogeneity and slightly lowered the 6‑month estimate (to 94%), with negligible change at 12 months. At 6 months, viral suppression was higher in those transitioning than initiating ART (98% vs. 94%, p < 0.01), with similar rates at 12 months (97%, p = 0.67). The pooled intention-to-treat 12-month viral suppression rate was 89% (82-93%, I² = 95%), with no significant difference by ART status (initiating 86% vs. transitioning 91%, p = 0.44).
Conclusion: Adults retained in care receiving WHO-recommended first-line dolutegravir-based ART achieved viral suppression rates of ≥ 95% up to two years. These findings align with the UNAIDS 95% suppression target and reinforce the role of dolutegravir-based regimens in ending HIV as a public health threat.
期刊介绍：
AIDS Research and Therapy publishes articles on basic science, translational, clinical, social, epidemiological, behavioral and educational sciences articles focused on the treatment and prevention of HIV/AIDS, and the search for the cure. The Journal publishes articles on novel and developing treatment strategies for AIDS as well as on the outcomes of established treatment strategies. Original research articles on animal models that form an essential part of the AIDS treatment research are also considered
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
