Incidence and factors associated with discontinuation of dolutegravir in individuals starting antiretroviral therapy in Brazil: a retrospective cohort study.

Incidence of dolutegravir (DTG) discontinuation is higher and wider in real-world studies than in clinical trials, with different associated factors. In Brazil, evidence on this matter remains scarce, representing a major gap in the literature. Therefore, this study assessed the incidence and factors associated with DTG discontinuation among patients initiating antiretroviral therapy (ART) in Brazil. A retrospective cohort study was conducted using data from the Brazilian Ministry of Health, which included all individuals recorded in national information systems who initiated ART with DTG between 2017 and 2019 (n = 111,286). Sociodemographic, laboratory, and antiretroviral use data from this period were analyzed. Kaplan-Meier curves described the cumulative incidence and mean time to DTG discontinuation, with comparisons using the log-rank test. Univariate and multivariate logistic regression analyses evaluated factors associated with discontinuation, reporting crude and adjusted odds ratios with 95% confidence intervals. The incidence of DTG discontinuation was 17.9%. Multivariate analysis showed that female sex, lower education, non-white skin color, lower CD4+T cell counts, higher viral load, ART non-adherence, and adverse drug reactions significantly increased the likelihood of discontinuation. These findings provide evidence to support public policies and strategies in the Brazilian Unified Health System to reduce DTG discontinuation and improve outcomes for people living with HIV.