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. 2020 Apr 1;34(5):783-787.
doi: 10.1097/QAD.0000000000002470.

Challenges of scale-up to dolutegravir-based regimens in sub-Saharan Africa

Mounerou Salou  1 , Christelle Butel  2 , Adjo S Comlan  1 , Abla A Konou  1 , Kokou Tegueni  1 , Amivi Ehlan  1 , Fiali Lack  1 , Sika Dossim  1 , Ahidjo Ayouba  1 , Eric Delaporte  2 , Anoumou Y Dagnra  1   3 , Martine Peeters  2
Affiliations

Challenges of scale-up to dolutegravir-based regimens in sub-Saharan Africa

Mounerou Salou et al. AIDS. .

Abstract

Objective: Evaluate the potential effectiveness of the implementation of dolutegravir (DTG)-based regimens in patients on failing current antiretroviral treatment (ART) given the high levels of nucleoside reverse transcriptase inhibitor (NRTI) resistance in Togo.

Design: Patients on ART attending health facilities for routine follow-up visits and for whom HIV viral load test was performed were consecutively included.

Methods: Protease, reverse transcriptase and integrase fragments were sequenced and analyzed for presence of drug resistance mutations for patients with viral load more than 1000 copies/ml.

Results: Among 1681 patients, 320 (19.04%) had viral load more than 1000 copies/ml and 200 were tested for drug resistance mutations. Reverse transcriptase gene was successfully sequenced for 181/200 (90.5%) patients; 140/181 (77.4%) were resistant to NRTIs and non-NRTIs, 4/181 (2.2%) to NRTIs only and 18/181 (9.9%) to non-NRTIs only. Many viral strains accumulated mutations predicting resistance to NRTIs recommended in first and second-line DTG-based ART regimens. ART switch to a DTG-based regimen after viral load testing (viral load >1000 copies/ml) or blind switch without prior viral load testing to a new DTG-based first line, estimated 31% and 47.6% of patients to be potentially on functional DTG monotherapy respectively.

Conclusion: Overall, our results predict that, at the scale of sub-Saharan Africa a significant proportion of patients could be on functional monotherapy. To achieve the third 90 of UNAIDS objectives, implementation of DTG-based regimens should be accompanied with an accelerated scaling up of access to viral load. Studies designed to quantify the implications of use of suboptimal DTG-based regimens are also needed.

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