Dolutegravir-Based Regimen Ensures High Virological Success despite Prior Exposure to Efavirenz-Based First-LINE ART in Cameroon: An Evidence of a Successful Transition Model

Author:

Semengue Ezechiel Ngoufack Jagni,Fokam JosephORCID,Etame Naomi-Karell,Molimbou Evariste,Chenwi Collins AmbeORCID,Takou Désiré,Mossiang Leonella,Meledie Alain P.,Yagai BoubaORCID,Nka Alex Durand,Dambaya Beatrice,Teto Georges,Ka’e Aude Christelle,Beloumou Grâce Angong,Djupsa Ndjeyep Sandrine Claire,Abba AissatouORCID,Kengni Aurelie Minelle Ngueko,Tommo Tchouaket Michel CarlosORCID,Bouba Nounouce Pamen,Billong Serge-Clotaire,Sosso Samuel Martin,Colizzi Vittorio,Perno Carlo-Federico,Kouanfack Charles,Zoung-Kanyi Bissek Anne-Cecile,Eben-Moussi Emmanuel,Santoro Maria MercedesORCID,Ceccherini-Silberstein Francesca,Ndjolo Alexis

Abstract

To ensure optimal prescribing practices in the dolutegravir-era in Cameroon, we compared first-line virological response (VR) under tenofovir + lamivudine + dolutegravir (TLD) according to prior exposure to tenofovir + lamivudine + efavirenz (TLE). A facility-based survey was conducted among patients initiating antiretroviral therapy (ART) with TLD (I-TLD) versus those transitioning from TLE to TLD (T-TLD). HIV viral load was performed and unsuppressed participants (VL > 1000 copies/mL) had genotyping performed by Sanger sequencing. Of the 12,093 patients followed, 310 (mean-age: 41 ± 11 years; 52.26% female) complied with study criteria (171 I-TLD vs. 139 T-TLD). The median ART-duration was 14 (12–17) months among I-TLDs versus 28 (24.5–31) months among T-TLDs (15 (11–19) on TLE and 14 (9–15) on TLD), and 83.15% (148/178) were at WHO clinical stages I/II. The viral suppression rate (<1000 copies/mL) was 96.45%, with 97.08% among I-TLDs versus 95.68% among T-TLDs (p = 0.55). VR was similar in I-TLD versus T-TLD at <400 copies/mL (94.15% versus 94.42%) and age, gender, residence, ART-duration, and WHO stages were not associated with VR (p > 0.05). Genotyping was successful for 72.7% (8/11), with no major mutations to integrase inhibitors found. VR is optimal under first-line TLD after 14 months, even among TLE-exposed, thus confirming the effectiveness of transitioning from TLE to TLD in similar settings, supported by strong pharmacological potency and genetic barrier of dolutegravir.

Funder

Chantal BIYA international Reference Centre

Royal Society of Tropical Medicine and Hygiene

Publisher

MDPI AG

Subject

Virology,Infectious Diseases

Reference60 articles.

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