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Population Effectiveness of Dolutegravir Implementation in Uganda - A Prospective Observational Cohort Study (DISCO): 48-week Results.

Accepted version
Peer-reviewed

Type

Article

Change log

Authors

McCluskey, Suzanne M  ORCID logo  https://orcid.org/0000-0001-8463-5430
Muyindike, Winnie R  ORCID logo  https://orcid.org/0000-0002-6694-2645
Nanfuka, Victoria 
Komukama, Nimusiima 

Abstract

BACKGROUND: Tenofovir/lamivudine/dolutegravir (TLD) is the preferred first-line antiretroviral therapy (ART) regimen for people with HIV (PWH), including those who were previously virologically suppressed on non-nucleoside reverse transcriptase inhibitors (NNRTIs). We sought to estimate the real-world effectiveness of the TLD transition in Ugandan public-sector clinics. METHODS: We conducted a prospective cohort study of PWH ≥18 years who were transitioned from NNRTI-based ART to TLD. Study visits were conducted on the day of TLD transition and 24- and 48- weeks later. The primary endpoint was viral suppression (<200 copies/mL) at 48-weeks. We collected blood for retrospective viral load (VL) assessment and conducted genotypic resistance tests for specimens with VL >500 copies/mL. RESULTS: We enrolled 500 participants (median age of 47 years; 41% women). At 48-weeks after TLD transition, 94% of participants were in care with a VL <200 copies/mL (n = 469/500); 2% (n = 11/500) were lost from care or died; and only 2% (n = 9/500) had a VL >500 copies/mL. No incident resistance to DTG was identified. Few participants (2%, n = 9/500) discontinued TLD due to adverse events. CONCLUSIONS: High rates of viral suppression, high tolerability, and lack of emergent drug resistance support use of TLD as the preferred first-line regimen in the region.

Description

Keywords

HIV drug resistance, TLD, antiretroviral therapy, dolutegravir, sub-Saharan Africa

Journal Title

J Infect Dis

Conference Name

Journal ISSN

0022-1899
1537-6613

Volume Title

Publisher

Oxford University Press (OUP)

Publisher DOI

Sponsorship
Wellcome Trust (108082/A/15/Z)