Virologic outcomes on Dolutegravir-based therapy among children and adolescents living with HIV in Thailand: findings from a national registry database

Background
Dolutegravir (DTG)-based antiretroviral therapy (ART) is recommended for initial and subsequent ART for children and adolescents living with HIV (CALHIV). We evaluated virologic outcomes after starting DTG-based ART using the National AIDS Program (NAP) database in Thailand.
Methods
We conducted a cohort study including CALHIV aged <18 years at DTG start, with at least one viral load (VL) measurement after starting DTG-based ART. Outcomes were: (i) viral suppression (VS) (defined as VL < 1000 and <50 copies/mL), (ii) episodes of viremia (≥1 VL ≥ 1000 copies/mL), and (iii) among those with ≥2 VL measurements, confirmed virologic failure (VF) (two consecutive VL ≥ 1000 copies/mL). Cox regression models were used to assess factors associated with viremia and VF, and generalized estimating equations models to assess factors associated with rates of viremia over time.
Findings
Of 2395 CALHIV included, 49% were female and 69% were ART-experienced at DTG start. Median age at DTG start was 15 years (Interquartile range [IQR] 12–17). Over a median 1.55 years [1.05–1.92] on DTG and a median of 2 [1–2] VL measurements per participant, 84.3% had VS < 1000 copies/mL and 75.9% <50 copies/mL throughout follow-up; 15.7% experienced viremia. Among those with ≥2 VL measurements available, 7.1% had confirmed VF. In adjusted models, female sex and being ART-experienced with detectable VL at DTG start were associated with a significantly higher risk of viremia and VF. Rates of episodic viremia increased over time and varied by age, with higher rates among those aged < 6 years and 12–15 years at DTG start compared to children aged 6–<12 year.
Interpretation
Most CALHIV achieved viral suppression on DTG. Overall risk of virologic failure was low but was substantially higher among ART-experienced individuals with detectable VL at DTG start, underscoring the importance of close monitoring and targeted adherence support for vulnerable subgroups.

Additional information to the following link: Virologic outcomes on Dolutegravir-based therapy among children and adolescents living with HIV in Thailand: findings from a national registry database - The Lancet Regional Health - Southeast Asia