Incidence and factors associated with low-level viremia among children and adolescents living with HIV on dolutegravir- based regimens in Uganda.

BACKGROUND

Low-level viraemia (LLV), a precursor for virological failure occurs during antiretroviral therapy (ART). However, the burden and associated factors for LLV have not been explored in the era of DTG based regimens among children and adolescents living with HIV (CALHIV). Therefore, this study aimed to determine the incidence and factors associated with LLV among children and adolescents on DTG based regimens in two centers of excellence in Uganda.

METHODS

This was a retrospective observational study in The AIDS Support Organization (TASO) Gulu and Mbarara centers of excellence in Northern and Western Uganda, respectively. Anonymized records of CALHIV who were active in care and were established on DTG based regimens from January 2020 to December 2023 were abstracted between 7th and 22nd September 2025. The participants were followed from the date of the first viral load at least 6 months after initiation on DTG based regimen until loss to follow up or administrative censoring. The associated factors for LLV were determined using modified Poisson regression.

RESULTS

A total of 616 participants were enrolled in this study. The mean age of participants was 14.8 ± 4.3 years, 55.5% were female and the majority (86.2%, n = 531) aged 10-19 years. The overall incidence of LLV was 32.1 per 100 person-years (95% CI: 28.7-35.9), with a median time to LLV of 2.18 years. LLV was observed in 22.2% of the study participants. Factors associated with LLV included male sex (aPR (adjusted prevalence ratio) 0.84, 95% CI: (0.75-0.94), p = 0.002), more than 5 years duration on ART (aPR: 1.73, 95% CI: 1.26-2.37, p = 0.001), second ART regimen line (aPR: 1.13, 95% CI: 1.02-1.24, p = 0.017, third ART regimen line (aPR: 0.37, 95% CI: 0.33-0.43, p < 0.001), CD4 count <200 cells/μL (aPR: 1.34, 95% CI: 1.18-1.53, p <0.001), stigma (aPR: 7.25, 95% CI: 5.76-9.13, p < 0.001), and malnutrition (aPR: 8.40, 95% CI: 7.57-9.32, p < 0.001).

CONCLUSIONS

The incidence of LLV among CALHIV on DTG-based regimens was high. These findings highlight the need to strengthen psychosocial interventions to maintain viral suppression in CALHIV on DTG.