HIV viral suppression in children and adolescents who transitioned from ritonavir-boosted lopinavir- to dolutegravir-based antiretroviral therapy in Lesotho.

OBJECTIVES

Children and adolescents living with HIV previously taking ritonavir-boosted lopinavir (LPV/r)-based antiretroviral therapy (ART) have been programmatically transitioned to dolutegravir (DTG)-based regimens in many country programs. We aimed to describe treatment outcomes following this transition in Lesotho, southern Africa.

DESIGN

We analyzed routinely collected data from two open cohorts across 27 health facilities in Lesotho.

METHODS

We included children and adolescents (<18 years at transition to DTG) who transitioned from first- or second-line ART consisting of LPV/r and 2 nucleoside reverse transcriptase inhibitors (NRTIs) to DTG and 2 NRTIs between July 2019 and July 2023. We report viral load (VL) data before transition, 12 months post-transition, and 24 months post-transition.

RESULTS

Among 852 participants, 410 (48.1%) were female, the median age was 10.1 years (interquartile range [IQR] 7.6-13.0) and the median time on ART at transition was 8.1 years (IQR 5.6-11.1). Of 768 with a pre-transition VL, 617 (80.3%) had viral suppression (VS; <50 copies/mL), 85 (11.1%) had low-level viremia (LLV; 50-999 copies/mL), and 66 (8.6%) had a high VL (HVL; ≥1000 copies/mL). Among 822 with a 12-month post-transition VL, 721 (87.7%) had VS, 76 (9.2%) had LLV and 25 (3.0%) had HVL. Among 787 with 24-month post-transition VL, 686 (87.2%) had VS, 75 (9.5%) had LLV and 26 (3.3%) had HVL.

CONCLUSION

We observed improved and sustained VS among children and adolescents in routine care in Lesotho after programmatic transition to DTG-based ART, supporting continued scale-up of DTG in paediatric HIV programmes.