The Lancet regional health. Africa · 2026
Virologic outcomes among people living with HIV on dolutegravir-based antiretroviral therapy in Kenya, 2018-2024: a comparison retrospective longitudinal analysis.
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Chun Helen M, Pals Sherri L, Gikura Mary, Akinyi Pacific, Odhiambo Ashley, Dirlikov Emilio, Aoko Appolonia, Kinoti Freda, Milligan Kyle, Moturi Ruzuna, Mecha Jared, Njigua Catherine, Muthoni Junghae, Basiye Frank, Masamaro Kenneth
Аннотация
BACKGROUND: Long-term virologic outcome data of tenofovir fumarate disoproxil-lamivudine-dolutegravir (TLD) versus tenofovir fumarate disoproxil-lamivudine-efavirenz (TLE) from resource-constrained settings remain limited. This study evaluates virologic suppression (VS) among people living with HIV (PLWH) ≥15 years in Kenya following TLD introduction in 2019.
METHODS: We analyzed Kenya's National AIDS and STIs Control Programme data (2018-2024) including ART-naïve and treatment-experienced PLWH initiating TLD (TLD1), transitioning to TLD (TLD2), or initiating TLE (TLE1). Outcomes included virologic suppression (VS: <1000 copies/mL)-including undetectable (UD: <50 copies/mL), durable undetectable (durable UD: <50 copies/mL for the three most recent results), and low-level viremia (LLV: 50-999 copies/mL), viral load non-suppression (VLNS: ≥1000 copies/mL), and virologic failure (VF: ≥2 consecutive VLNS). We fit logistic regression models to assess associations with virologic outcomes.
FINDINGS: Among 1,072,209 PLWH records, 758,398 (70.7%) had ≥1 VL. VS was highest in TLD2 (96.3-97.1%), followed by TLD1 (94.4-96.2%) and TLE1 (91.1-92.7%). Long-term VS (at 24-36 months) exceeded 95% for TLD1 and TLD2 but remained approximately 92% for TLE1 (p < 0.0001). Durable UD was higher in TLD2 (aOR) 1.95 [95% CI 1.88-2.01] and TLD1 (aOR 1.56 [95% CI 1.51-1.61]; p < 0.0001) versus TLE1, even with initial VLNS: TLD1 (aOR 2.31 [95% CI 1.94-2.76] and TLD2 aOR 2.39 [95% CI 2.00-2.85]). Even with initial VS, adolescents (15-19 years) had higher odds of VF: females aOR 2.07 [95% CI 1.49-2.87] and males aOR 5.39 [95% CI 3.64-7.98]. Pre-transition and initial LLV increased the risk of post-transition VLNS (aOR 1.51 [95% CI 1.42-1.60]; p < 0.0001) and VF, highest at 500-999 copies/mL (aOR 3.88 [95% CI 3.33-4.53]; p < 0.0001).
INTERPRETATION: Kenya's ART optimization with TLD was associated with superior outcomes compared to TLE, with higher early and sustained VS, better re-suppression post-VF, and improved durability of UD. Targeted interventions are needed for adolescents, those with LLV, and higher pre-transition VL to enhance long-term virologic control and end HIV as a public health threat.
FUNDING: No specific funding was received for the analysis. HIV program support was provided by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the CDC.
METHODS: We analyzed Kenya's National AIDS and STIs Control Programme data (2018-2024) including ART-naïve and treatment-experienced PLWH initiating TLD (TLD1), transitioning to TLD (TLD2), or initiating TLE (TLE1). Outcomes included virologic suppression (VS: <1000 copies/mL)-including undetectable (UD: <50 copies/mL), durable undetectable (durable UD: <50 copies/mL for the three most recent results), and low-level viremia (LLV: 50-999 copies/mL), viral load non-suppression (VLNS: ≥1000 copies/mL), and virologic failure (VF: ≥2 consecutive VLNS). We fit logistic regression models to assess associations with virologic outcomes.
FINDINGS: Among 1,072,209 PLWH records, 758,398 (70.7%) had ≥1 VL. VS was highest in TLD2 (96.3-97.1%), followed by TLD1 (94.4-96.2%) and TLE1 (91.1-92.7%). Long-term VS (at 24-36 months) exceeded 95% for TLD1 and TLD2 but remained approximately 92% for TLE1 (p < 0.0001). Durable UD was higher in TLD2 (aOR) 1.95 [95% CI 1.88-2.01] and TLD1 (aOR 1.56 [95% CI 1.51-1.61]; p < 0.0001) versus TLE1, even with initial VLNS: TLD1 (aOR 2.31 [95% CI 1.94-2.76] and TLD2 aOR 2.39 [95% CI 2.00-2.85]). Even with initial VS, adolescents (15-19 years) had higher odds of VF: females aOR 2.07 [95% CI 1.49-2.87] and males aOR 5.39 [95% CI 3.64-7.98]. Pre-transition and initial LLV increased the risk of post-transition VLNS (aOR 1.51 [95% CI 1.42-1.60]; p < 0.0001) and VF, highest at 500-999 copies/mL (aOR 3.88 [95% CI 3.33-4.53]; p < 0.0001).
INTERPRETATION: Kenya's ART optimization with TLD was associated with superior outcomes compared to TLE, with higher early and sustained VS, better re-suppression post-VF, and improved durability of UD. Targeted interventions are needed for adolescents, those with LLV, and higher pre-transition VL to enhance long-term virologic control and end HIV as a public health threat.
FUNDING: No specific funding was received for the analysis. HIV program support was provided by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the CDC.