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  • OA-770 Treatment outcomes of low-level viremia among adults living with HIV on dolutegravir-based first line antiretroviral therapy in Botswana

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OA-770 Treatment outcomes of low-level viremia among adults living with HIV on dolutegravir-based first line antiretroviral therapy in Botswana
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  1. Ontlametse T Bareng1,2,
  2. Sikhulile Moyo1,3,
  3. Mbatshi Mudanga4,
  4. Kagiso Sebina4,
  5. Catherine Koofhethile1,3,
  6. Wonderful Choga1,2,
  7. Irene Gobe2,
  8. Modisa Motswaledi2,
  9. Docas Maruapula1,
  10. Natasha Moraka1,2,
  11. Rosemary Musonda1,
  12. Joseph Nkomo5,
  13. Dinah Ramaabya5,
  14. Tony Chebani5,
  15. Penny Makuruetsa5,
  16. Joseph Makhema1,3,
  17. Simani Gaseitsiwe1,3
  1. 1Botswana Harvard Aids Institute, Botswana
  2. 2Department of Medical Sciences, Faculty of Allied Health Professions, University of Botswana, Botswana
  3. 3Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, USA
  4. 4BUMMHI, Botswana
  5. 5Ministry of Health, Botswana

Abstract

Background We evaluated the treatment outcomes of individuals experiencing low-level viremia (LLV) on dolutegravir (DTG) based first-line antiretroviral therapy (ART) in Botswana by determining the trends of LLV over a period of 6 years.

Methods We used a large national observational cohort of individuals (aged≥18yrs) who initiated on DTG-based first-line ART for at least 3 months from June 2016 to December 2022. The prevalence of viral suppression (VL ≤50copies/mL), low-level viremia (VL:51-999copies/mL) and virologic failure (VF) (any VL>1000copies/mL) were estimated among PLWH. The prevalence of LLV was further classified into LLV ranges (low-LLV:VL:51-200copies/mL, medium-LLV:201-400copies/mL and high-LLV:VL:401-999copies/mL). Univariate and multivariable Cox proportional hazards regression determined whether LLV (exposure) is associated with VF (outcome).

Results Among 50,742 PLWH who have at least one VL measurement during the follow-up, the overall prevalence of LLV by duration strata was 2.2%, 1.8%, 1.7%, 2.3%, 3.1%, 3.7% and 3.9% at 0.25-<0.5, 0.5-≤1, 2, 3, 4, 5, 6+ years respectively. By LLV ranges, ≥90% had low-LLV in each duration strata. A total of 539 had reported LLV at year 0.25-<0.5 whereby 529(98.1%) had single instance of LLV, 9(1.7%) with 2-consecutive-LLV (confirmed) and 1 (0.2%) had at-least-3-LLV(persistent) measurements. The prevalence of PLWH with confirmed-LLV was 9.1%, 9.0%, 7.3%, 6.4%, 9.1% and 8.4% at 0.5-≤1, 2, 3, 4, 5, 6+ years of the follow-up period, respectively. The prevalence of persistent-LLV increased from 0.2% to 7.0% from year 0.25-<0.5 to 6+. PLWH with LLV had an increased risk of VF (adjusted-Hazards-Ratio [aHR] 2.65; 95%CI 2.16–3.26) at a later visit compared to suppressed VL group. High-LLV and persistent-LLV were the main LLV factors associated with VF.

Conclusion The prevalence of LLV ranging from 1.7–3.9% was found in this cohort. Having a high or persistent-LLV is associated with a high risk of subsequent VF. Intensified clinical monitoring strategies are warranted for individuals with LLV.

https://doi.org/10.1136/bmjgh-2023-EDC.53

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