Abstract / Summary
Benin has adopted the 2019 WHO recommendations by including dolutegravir in the first-line treatment regimen. Dolutegravir has a high genetic barrier and has demonstrated efficacy against HIV-1 strains in treatment-adherent patients worldwide. The objective of this study was to conduct a descriptive assessment of the evolution of HIV-1 viral load among patients receiving dolutegravir-based antiretroviral therapy (ART) in Benin. A retrospective cross-sectional study without a comparison group or pre-dolutegravir reference group was conducted among routine patients attending LNR/PSLS from January 1st to December 31st, 2024. Viral load (VL) quantification was performed using Abbott Real Time(®) HIV-1. VL < 1000 copies/mL was qualified “suppressed” and VL detected was ≥ 1000 copies/mL. Data laboratory viral load and ART regimen lines records were extracted from the facilities register care. Univariate and multivariate logistic regression was used to assess the association between participant’s characteristics (regimen type, sex, age) and viral load undetectable and suppression. Because age was associated with regimen type, only sex and regimen type were included in the multivariable model. Statistical analyzes were performed using Statistica 7.0 software and Excel 2022 spreadsheet (Microsoft Corporation, Redmond, WA, USA). Seventeen thousand and one patients were included in the study. Of the 17001 patients, men represented 29.7% and women 70.3%. Adults (92.1%) were under TDF/AZT+3TC+DTG and children (7.9%) under ABC/TDF+3TC+DTG.Overall, approximatively ninety-one percent of participants achieved VL suppression, with a lower proportion of children (7.2%) than adults (92.8%) (p < 0.0001). The low level replication viremia and undetectable VL represented 31.5% and 68.5% respectively (p < 0.0001). The proportion of men with undetectable VL was low (24.6%) compared to women (69.1%) (p < 0.001). The proportion of undetectable VL in boys (3.1%) and girls (3.2%) was not statistically different (p = 0.63). Multivariate analysis showed that patients receiving AZT/TDF+3TC+DTG had higher odds of achieving an undetectable VL (AOR = 1.13, 95% CI: 1.10–1.16) and viral load suppression (AOR = 1.08, 95% CI: 1.06–1.10) than those receiving ABC/TDF+3TC+DTG. Male sex was independently associated with lower odds of achieving an undetectable VL (AOR = 0.95; 95% CI: 0.93 - 0.96), whereas no significant association was observed with viral load suppression. In the univariate analysis among adults, men had lower odds of achieving an undetectable viral load than women (OR = 0.94, p < 0.0001), corresponding to approximately 6% lower odds. No statistically significant association between sex and viral load suppression was observed. In children, no statistically significant difference was observed between boys and girls, either for achieving an undetectable viral load or for viral suppression. The study revealed a significantly higher HIV-1 viral load suppression rate in adults than in children among patients receiving dolutegravir-based combination antiretroviral therapy in Benin. The undetectable viral load suppression rate was also significantly higher in women than in men. The proportion of patients with undetectable HIV-1 viremia was higher than that with low viremia. As many girls as boys present with undetectable HIV-1 viremia. The proportion of patients with HIV-1 viral loads greater than 1,000 copies/mL was higher in women than in men.