Dolutegravir based therapy showed CD4+ T cell count recovery and viral load suppression among ART naïve people living with HIV AIDS: a pilot evaluation

Abstract

Recently, dolutegravir (DTG)-based combined therapy, a more effective and safer first-line antiretroviral therapy (ART), has been recommended by the World Health Organization for the treatment of Human Immunodeficiency Virus (HIV) since July 2018. However, its effectiveness in CD4⁺ T-cells count recovery and viral load suppression has not been studied yet in Ethiopia, where HIV is endemic. Therefore, we aimed to conduct a pilot assessment on the effect of DTG-based therapy on CD4⁺ T-cell count and viral load count among people living with HIV (PLWH) in Ethiopia. A longitudinal prospective cohort study was conducted from July 2020 to February 2021. 109 PLWH who are ART naive but plan to initiate DTG-based therapy were recruited. HIV viral ribonucleic acid (RNA) copies were determined using polymerase chain reaction. To compute the difference in viral load and CD4⁺ T-cell counts between the baseline, 3rd, and 6th months, a Friedman test was used. The study included 109 PLWH who had never received antiretroviral medication. Participants taking DTG-based treatment showed significantly decreasing median (IQR) values of viral load count (copies/mL) from 446,812 (237649.5-732994.5) at baseline to 34 (23.5-46) at 3 months and 0.0 (0-19) at 6 months of treatment follow-up. Although the treatment increases the proportion of participants with HIV-1 RNA 50 copies/mL from 0 (0% at baseline) to 87 (79.8%) and 100 (91.7%) at the 3rd and 6th months of treatment, respectively, On the other hand, the CD4⁺ T-cell count increased significantly during treatment: median (IQR): 209 (81.5-417.5) versus 291 (132-522) versus 378 (181-632.5) cells/L at baseline, the 3rd and 6th months of the treatment follow-up period, respectively. We found dolutegravir-based therapy was a promising option with high virological suppression rates and CD4⁺ T-cell count recovery, demonstrating a restoration of cellular immunity. Moreover, Viral load suppression rates were high after the initiation of the treatment. We recommend further research should be conducted with a larger number of participants to acquire greater awareness of the treatment outcomes.

Figure 1

Effect of dolutegravir based therapy on viral load counts among ART naïve participants in Gondar, Ethiopia. The above line graph indicates the viral load suppression from baseline according to antiretroviral regimens at different periods of treatment. A Friedman test was used to compute the difference in viral load counts between the baseline, 3rd, and 6th months. *Statistically significant at P < 0.05, **statistically significant at P < 0.01, ***statistically significant at P < 0.001.

Figure 2

Dolutegravir based therapy has a significant effect on viral load across the BMI categories among treatment naïve individuals in Gondar, Ethiopia. Histogram (a) showing the baseline differences of viral load count across BMI categories and Histogram (b) showing the rate of viral load suppression (copies/ml/months) by BMI categories between the different periods following ART. Friedman test was used to compute the difference in viral load counts between the baseline, 3rd, and 6th months of follow-up period under the BMI categories. *Statistically significant at P < 0.05, **statistically significant at P < 0.01, ***statistically significant at P < 0.001.

Figure 3

Dolutegravir based therapy has a significant effect on viral load across WHO clinical stage among PLWH individuals in Gondar, Ethiopia. Histogram (a) showing the baseline differences of viral load count with WHO C. Stage of HV. And Histogram (b) showing the rate of viral load suppression (copies/ml/months) under-WHO clinical stage of HIV between the different periods following ART. Friedman test was used to compute the difference in viral load counts between the baseline, 3rd, and 6th months of follow-up period under WHO clinical stage. *Statistically significant at P < 0.05, **statistically significant at P < 0.01, ***statistically significant at P < 0.001.

Figure 4

Effect of dolutegravir based therapy on CD4⁺ T cell counts. The above line graph indicates the CD4⁺ T-cell count change from baseline according to antiretroviral regimens at different periods of treatment. Friedman test was used to compute the difference in CD4⁺ T-cell counts between the baseline, 3rd, and 6th months of follow-up period. *Statistically significant at P < 0.05, **statistically significant at P < 0.01, ***statistically significant at P < 0.001.

Figure 5

Dolutegravir based therapy has a significant effect on CD4⁺ T-cell count across the BMI categories. Histogram (a) showing the baseline differences of CD4⁺—T cell count across the BMI categories and Histogram (b) showing the rate of CD4⁺ T-cell count increased (cells/µL/months) by BMI group between the different periods of ART follow-up. Friedman test was used to compute the difference in CD4⁺ T-cell counts between the baseline, 3rd, and 6th months of follow-up period. *Statistically significant at P < 0.05, **statistically significant at P < 0.01, ***statistically significant at P < 0.001.

Figure 6

Dolutegravir based therapy has a significant effect on CD4⁺ T-cell count across WHO clinical stage. Histogram (a) showing the baseline differences of CD4⁺ T- cell count across WHO C. Stage of HV and Histogram (b) showing the rate of CD4⁺ T-cell count increased (cells/µL/months) by WHO clinical stage of HIV between the different periods following ART. Friedman test was used to compute the difference in CD4⁺ T-cell counts between the baseline, 3rd, and 6th months of follow-up period. *Statistically significant at P < 0.05, **statistically significant at P < 0.01, ***statistically significant at P < 0.001.