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. 2024 May 1;16(5):720.
doi: 10.3390/v16050720.

Low-Level Viremia among Adults Living with HIV on Dolutegravir-Based First-Line Antiretroviral Therapy Is a Predictor of Virological Failure in Botswana

Ontlametse T Bareng  1   2 , Sikhulile Moyo  1   3   4   5 , Mbatshi Mudanga  6 , Kagiso Sebina  6 , Catherine K Koofhethile  1   3 , Wonderful T Choga  1   2 , Natasha O Moraka  1   2 , Dorcas Maruapula  1 , Irene Gobe  2 , Modisa S Motswaledi  2 , Rosemary Musonda  1 , Bornapate Nkomo  7 , Dinah Ramaabya  7 , Tony Chebani  7 , Penny Makuruetsa  7 , Joseph Makhema  1   3 , Roger Shapiro  1   3 , Shahin Lockman  1   3   8 , Simani Gaseitsiwe  1   3
Affiliations

Low-Level Viremia among Adults Living with HIV on Dolutegravir-Based First-Line Antiretroviral Therapy Is a Predictor of Virological Failure in Botswana

Ontlametse T Bareng et al. Viruses. .

Abstract

We evaluated subsequent virologic outcomes in individuals experiencing low-level virem ia (LLV) on dolutegravir (DTG)-based first-line antiretroviral therapy (ART) in Botswana. We used a national dataset from 50,742 adults who initiated on DTG-based first-line ART from June 2016-December 2022. Individuals with at least two viral load (VL) measurements post three months on DTG-based first-line ART were evaluated for first and subsequent episodes of LLV (VL:51-999 copies/mL). LLV was sub-categorized as low-LLV (51-200 copies/mL), medium-LLV (201-400 copies/mL) and high-LLV (401-999 copies/mL). The study outcome was virologic failure (VF) (VL ≥ 1000 copies/mL): virologic non-suppression defined as single-VF and confirmed-VF defined as two-consecutive VF measurements after an initial VL < 1000 copies/mL. Cox regression analysis identified predictive factors of subsequent VF. The prevalence of LLV was only statistically different at timepoints >6-12 (2.8%) and >12-24 (3.9%) (p-value < 0.01). LLV was strongly associated with both virologic non-suppression (adjusted hazards ratio [aHR] = 2.6; 95% CI: 2.2-3.3, p-value ≤ 0.001) and confirmed VF (aHR = 2.5; 95% CI: 2.4-2.7, p-value ≤ 0.001) compared to initially virally suppressed PLWH. High-LLV (HR = 3.3; 95% CI: 2.9-3.6) and persistent-LLV (HR = 6.6; 95% CI: 4.9-8.9) were associated with an increased hazard for virologic non-suppression than low-LLV and a single-LLV episode, respectively. In a national cohort of PLWH on DTG-based first-line ART, LLV > 400 copies/mL and persistent-LLV had a stronger association with VF. Frequent VL testing and adherence support are warranted for individuals with VL > 50 copies/mL.

Keywords: Botswana; dolutegravir-based first line antiretroviral therapy; low level viremia; people living with HIV.

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Conflict of interest statement

The other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Schema for selection of study participants. ART-antiretroviral therapy, DTG—dolutegravir, LLV—low level viremia, PLWH—people living with HIV, TLD—tenofovir-lamivudine-dolutegravir, VL—viral load.
Figure 2
Figure 2
Prevalence of viral load groups by time since DTG-based first-line ART initiation. DTG—dolutegravir, LLV—low level viremia, n—PLWH with VL measurement at the timepoint, n.a—PLWH with no VL at the timepoint, VL—viral load.
Figure 3
Figure 3
Treatment outcomes among PLWH on DTG based first-line ART. DTG—dolutegravir, LLV—low level viremia, VF—Virologic failure, VL—viral load.
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