CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

982

HIV Viral Suppression Among Children and Adolescents 2 Years After Transition to Dolutegravir Akash Devendra 1 , Maurus Kohler 2 , Motlatsi Letsika 1 , Hape Khooa 1 , Lipontšo Motaboli 3 , Malebanye Lerotholi 2 , Nadine Tschumi 2 , Niklaus D Labhardt 2 , Jennifer A. Brown 2 1 Baylor College of Medicine Children's Foundation, Maseru, Lesotho, 2 University Hospital Basel, Basel, Switzerland, 3 SolidarMed, Maseru, Lesotho Background: Children and adolescents with HIV experience high rates of treatment failure. Antiretroviral therapy (ART) containing dolutegravir has recently been rolled out across much of Africa and has several potential benefits over previously preferred ART regimens, though long-term real-world data in pediatric populations are lacking. Here, we report treatment outcomes among children and adolescents in Lesotho, southern Africa, who transitioned from non-nucleoside reverse transcriptase inhibitor- (NNRTI-) to dolutegravir-based ART through two years' follow-up. Methods: Data were derived from two open cohort studies in Lesotho (Baylor College of Medicine Children's Foundation Lesotho and Viral Load Cohort North East Lesotho). Children and adolescents aged <18 years who transitioned from NNRTI- (efavirenz or nevirapine) to dolutegravir-based ART ≥18 months before data closure were included. We report viral load (VL) results <12 months before, 12 (window: 6-17) months after, and 24 (window: 18-29) months after transition to dolutegravir. Associations of demographic and clinical factors with 24-month viremia were assessed through multivariable logistic regression. Results: Among 2121 children and adolescents included, 1099 (51.8%) were female. At transition to dolutegravir, median age was 14.0 years (interquartile range [IQR] 11.5-15.8), median time taking ART was 7.6 years (IQR 4.4-10.6), and most participants had been taking an efavirenz-based regimen (1433/2121 (67.6%)). Participants were followed up over a median of 2.6 years (IQR 2.3-2.9). A VL was available for 1971/2121 (92.8%) <12 months before, 2006/2121 (94.6%) 12 months after, and 1887/2121 (89.0%) 24 months after transition to dolutegravir. Among those with a VL result at the respective time points, viral suppression to <50 copies/mL was achieved by 1633/1971 (82.9%) <12 months before, 1840/2006 (91.7%) 12 months after, and 1708/1887 (90.5%) 24 months after transition to dolutegravir. The Figure shows VL dynamics for participants with VL data at all time points. Pre-transition viremia was associated with viremia at 24 months, though 227/272 (83.5%) and 232/272 (85.3%) participants with pre-transition viremia had achieved resuppression to <50 copies/mL at 12- and 24 months after transition to dolutegravir, respectively. Conclusion: Rates of viremia dropped after transition to dolutegravir. However, further progress is needed to reach global targets in children and adolescents.

983

Longitudinal Viral Outcomes in Kenyan Youth With HIV Switching to Dolutegravir-Based Therapy Vlad Novitsky 1 , Winstone Nyandiko 2 , Allison DeLong 1 , Edwin Sang 3 , Joel Hague 1 , Ashley Chory 4 , Josephine Aluoch 3 , Eslyne Jepkemboi 3 , Millicent Orido 3 , Joseph Hogan 1 , Rachel Vreeman 4 , Rami Kantor 1 1 Brown University, Providence, RI, USA, 2 Moi University, Eldoret, Kenya, 3 Academic Model Providing Access to Healthcare, Eldoret, Kenya, 4 Icahn School of Medicine at Mt Sinai, New York, NY, USA Background: Dolutegravir (DTG)-based antiretroviral therapy (ART) is now recommended in all treatment lines in resource limited settings. Data on global implementation and longitudinal impact of DTG rollout for children and adolescents living with HIV (CAWH) are currently needed to inform care and policy. Methods: In a well characterized longitudinal cohort (since 2010) of perinatally infected CAWH cared for at the Academic Model Providing Access to Health care (AMPATH) in western Kenya, we determined viral outcomes, and compared outcomes between CAWH with and without provider-initiated switch to DTG based regimens. During the 18-month follow up, viral load (VL) was tested at 6-month intervals and drug resistance genotyping was performed for VL>1,000 copies/mL, and interpreted with Stanford HIV Drug Resistance Database tools. Differences in proportions were estimated using Fisher's exact test. Results: Of 390 CAWH followed for 18 months between July 2020-February 2023 (median age 19 years; 48% female; median 13 years on ART), 83% switched to DTG-based regimens and 17% remained on older regimens (2% NNRTI- and 98% PI-based). Among 324 CAWH on DTG-based regimens at 18 months, 293 (90%) were suppressed at that timepoint, 103 (32%) had VL>40 copies/mL, and 64 (20%) had VL>1,000 copies/mL at any follow up time point. Among 66 CAWH on non-DTG-based regimens, 47 (71%) were suppressed at 18 months (p<0.005), 37 (56%) had VL>40 copies/mL, and 30 (45%) had VL>1,000 copies/mL at any follow up time point. Of 186 patient-visits with VL>1,000 copies/mL in at least one timepoint during follow up, 141 sequences were available, including 69 from 52/324 (16%) CAWH on DTG-based regimens and 72 from 37/66 (56%) CAWH on non-DTG-based regimens. Any drug resistance was present in 58% of those on DTG-based, and in 86% of those on non-DTG-based regimens (p<0.01), including major PI drug resistance mutations (DRMs) in 2% vs. 16% (p<0.02), NRTI DRMs in 27% vs. 68% (p<0.001) and NNRTI DRMs in 46% vs. 78% (p<0.01), respectively. No major INSTI DRMs were detected, with accessory INSTI DRMs identified in 12% vs. 11% (p-value not significant). Conclusion: Longitudinal data in Kenyan CAWH support switching to DTG based ART to improve viral suppression and prevent resistance accumulation. Lack of major INSTI DRMs during this short follow up is encouraging, yet cumulative viral failures, including low level viremia, mandate close monitoring of adherence, VL and resistance in this vulnerable population.

Poster Abstracts

CROI 2024 313