Effectiveness of a dolutegravir-based regimen in HIV-1 patients attending the Bamenda Regional Hospital Treatment Centre, Cameroon: a retrospective observational study

<title>Abstract</title> <p>Background Improving current and future antiretroviral treatment is crucial to ending AIDS by 2030. Treatment failure, drug toxicity and resistance remain major obstacles to durable viral suppression. In 2019, the World Health Organization (WHO) recommended a dolutegravir-based regimen (DTG) as preferred first- and second-line antiretroviral therapy to help address these challenges. However, data on its real-world impact on viral suppression among routine patients remain scarce. This study evaluated the rate of viral suppression among HIV-1 patients receiving DTG in a real-world clinical setting in Cameroon. Methods This retrospective observational study was conducted at the Bamenda Regional Hospital HIV Treatment Centre. It included the medical records of HIV-1 patients aged above 18 years, with an adherence rate of at least 95%, without comorbidities, who received dolutegravir as part of combined antiretroviral therapy (cART) between January 2020 and May 2022. The primary outcome was virologic suppression, defined as a plasma HIV-1 viral load below 1000 copies/mL at 6 months (week 24) and 12 months (week 48). Secondary outcomes included the incidence of and reasons for DTG discontinuation at 12 months, and factors associated with sustained viral suppression. Results A total of 157 participants were included. At 6 months, the rate of virologic suppression was 95.5%, and 4.5% of participants had not achieved suppression. At 12 months, the rate of virologic suppression was 99.4%, with 0.6% of participants experiencing virologic failure leading to treatment discontinuation. There was no association between persistent viral suppression and advanced HIV disease at diagnosis. Alcohol use at baseline was significantly associated with viral suppression at 6 months (p = 0.002). By week 48, the median weight change in the study population was + 2.0 kg (interquartile range [IQR] 0 to 4). Conclusions In this real-world cohort, DTG-based cART demonstrated excellent virologic effectiveness at both 24 and 48 weeks, irrespective of baseline HIV disease stage, supporting its continued use as the preferred regimen for HIV-1 management in similar resource-limited settings.</p>