Treatment Outcomes with Dolutegravir (DTG)
Over the past three decades, antiretroviral therapy (ART) has transformed HIV into a manageable chronic condition. A major milestone in this progress was the global rollout of dolutegravir (DTG)-based regimens, which has been recommended by the World Health Organization for most people with HIV since 2018 and is now used by over 25 million people. DTG is well-tolerated and highly effective, and has replaced older regimens in most settings.
In Lesotho, VICONEL allowed for near real-time monitoring of treatment outcomes as DTG was introduced into routine care. The observational DO-REAL study was nested within VICONEL to provide early real-world evidence, confirming high rates of viral suppression and a possible reduction of some neuropsychiatric symptoms. Longer-term follow-up within VICONEL confirmed sustained viral suppression among both children and adolescents as well as adults transitioning from NNRTI- to DTG-based regimens. Importantly, the cohort also showed that low-level viraemia—even with DTG—predicted later treatment failure, supporting the World Health Organization’s decision in 2021 to lower the viral load threshold for defining treatment failure from 1000 to 50 copies/mL.
In parallel, the LoDoCA study, also embedded within VICONEL, examined treatment satisfaction and side effects in children and adolescents switching from ritonavir-boosted lopinavir- to DTG-based ART. LoDoCA focused on gastrointestinal and neuropsychiatric symptoms, offering valuable insights into pediatric ART tolerability and adherence in real-world settings.
Funding:
Swiss National Science Foundation, grant numbers IZ07Z0_160876/1 and PCEFP3_181355
Research Fund of the University of Basel, grant numbers 3ZX1404 and 3ZX1422
Principal Investigators: