The effectiveness of dolutegravir among HIV positive adolescents attending art clinic at benue State University Teaching Hospital, Makurdi, Benue State, Nigeria

Abstract

Background: Globally, HIV is the second leading cause of death among adolescents. These adolescents (10-19 years) make up 8% of people living with HIV (PLWH) in Nigeria with an HIV prevalence rate of 1.4%. They have poorer adherence, retention and rate of viral suppression than HIV-infected adults. To curb these issues, Dolutegravir (DTG) which is the third HIV integrase inhibitor (INI) has been initiated for them and for most clients.

Objective: In other to measure the effectiveness of DTG , this study compared the treatment outcomes between other ART combination and DTG based regimen among HIV positive adolescents attending antiretroviral therapy (ART) Clinic in Benue State University Teaching Hospital (BSUTH) Makurdi, Benue state, Nigeria.

Methods: A comparative descriptive study was employed to review 27 HIV positive adolescents on DTG regimen over a four year period from the clients date of commencement of ARVs to December 2021 in BSUTH ART clinic. All the adolescents (27) who were regular at their clinic appointment within that period were included in the study. Those who were identified from records who had commenced ART prior to the study period and had been changed from previous ART combination to a DTG based regimen were analyzed. Outcome measures of interest were: (1) Virological response; (virological suppression when Target is not detected, viral laod <50 which is low level viremia and viral load >50) (HIV-1 RNA viral load before and after commencement of DTG based ART regimen) (2) Intolerability (discontinuation) (3) Weight difference >1kg (at 0 and 6months of commencement of previous ART regimen without DTG and DTG based ART regimen)

Results: The mean age of respondents was approximately 14 years. Through period under review, virologic suppression rate was 82% (on-treatment analysis) for DTG based regimen and 11% for other ART based regimen. There were no discontinuations of DTG as it was well tolerated by the clients. By 6 months after commencement of DTG based regimen, the median change in weight for the study population was 9.1 kg on DTG regimen as compared to 3.5kg while on other ART based regimen.

Conclusion: In our cohort of adolescent male and female clients, DTG showed good virologic efficacy and was generally well tolerated.

Recommendation: More deliberate measures such as enhanced adherence counseling should be put in place to attain the 95-95-95 target among adolescent patients. Whether DTG results in undesirable weight gain or rather statistically significant results, remains a debate. Hence the use of DTG regimen for HIV-positive adolescents is strongly supporte