Early outcomes of South African children with persistent viral non-suppression following switch to dolutegravir-based antiretroviral therapy.

BACKGROUND: Since 2019 dolutegravir-based antiretroviral therapy (ART) has been introduced for South African children and adolescents living with HIV (CALHIV), including those with persistent viral non-suppression. Current guidelines recommend the reuse of abacavir when switching CALHIV weighing < 30 kg with persistent viral non-suppression to dolutegravir-based ART. OBJECTIVES: We aimed to describe the viral suppression rates, clinical outcomes and risk factors for non-suppression in CALHIV switching to dolutegravir-based ART following persistent viral non-suppression. METHOD: We performed a retrospective cohort study at Tygerberg Hospital in Cape Town, South Africa. RESULTS: We identified 39 children, 18 girls (46.2%). Median age at switch to a dolutegravir-based regimen was 7.2 years. Median duration on treatment pre-switch was 5.6 years. After switching to a dolutegravir-based regimen, 21 children (55.3%) achieved viral suppression. Abacavir was recycled with dolutegravir in 31 children (available viral load for 30/31) of whom 50.0% suppressed. Treatment interruptions were common, with 26 (66.7%) and 15 (38.5%) children experiencing at least one interruption in care before and after switching to a dolutegravir-based regimen, respectively. CONCLUSION: We provide evidence that recycling abacavir is safe in children with persistent viral non-suppression switching to dolutegravir. Supporting adherence and preventing therapy interruption is key to success.