ArticleBMC infectious diseases2026
Efficacy of dolutegravir-based therapy in achieving virological suppression in PLHIV in low- and middle-income countries: real-world evidence from a large clinical cohort in Cameroon.
Article in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Maintain, not obtain: rethinking HIV care in sub-Saharan Africa in the era of dolutegravir.Frontiers in public health · 2026Article
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28 authors.
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Abstract
backgroundHIV treatment has significantly improved with the introduction of potent antiretroviral therapy (ART), particularly dolutegravir (DTG)-based regimens. With suboptimal adherence reported in resource-limited settings (RLS), real-word evidence on DTG-effectiveness within ART clinics is limited. This study assessed virological response, drug resistance profiling and HIV-1 diversity among ART recipients at the Yaoundé Central Hospital (YCH), Cameroon.
methodsA facility-based study was conducted at YCH from May-2023 to February-2025. HIV plasma viral load (PVL) was measured by RT-PCR. Viral suppression (VS) was defined as PVL < 1,000copies/mL. Genotypic resistance testing (GRT) was performed for participants with PVL≥1,000copies/mL. Drug resistance mutations (DRMs) were interpreted using Stanford HIVdb v9.8 and statistics were performed with significance at p < 0.05.
resultsAmong 6,364 participants enrolled (median-age: 50 [IQR:42–59] years; 71% women), 76% (4,811/6364) were on DTG-based regimens. Median ART-duration was 13 [IQR:9.03–17.4] years, including 3.4 [IQR:3–5] years of DTG-exposure in the DTG-based sub-group. Overall, 93.2% (5,932/6,364) participants achieved VS in 2025; 94% among DTG-based versus 91% among DTG-sparing regimens (OR = 1.66; p = 0.000002). Interestingly, VS was higher with age ≥50years (aOR = 1.44; p < 0.001), DTG-based ART (aOR = 1.65; p < 0.0001) and DTG-exposure ≥3.4years (aOR = 1.29; p = 0.044). Between 2021 and 2025 specifically, VS remained consistently high among participants; with those on DTG-based showing significantly higher and more durable VS compared to those on DTG-sparing therapies (relative risk of failure > 1 for DTG-sparing throughout). Furthermore, from those virally unsuppressed in 2025, 9% (39/432) were lost-to-follow-up, 22% (94/432) were transfer-out to other health facilities and 65% (232/432) re-suppressed after enhanced adherence counselling; leaving us with 17 participants eligible for GRT (PVL≥1000copies/mL). GRT was successful for 70.5% (12/17) and DRMs detected in 83% (10/12), including major DRMs to protease inhibitors (17%), to nucleoside reverse transcriptase inhibitors (75%) and to non-nucleoside reverse transcriptase inhibitors (83%). CRF02_AG (75%) was the prevailing HIV-1 group M clade, followed by A3, D, and CRF18_cpx (each 8.3%).
conclusionThese real-life data reveal viral suppression rates closer to the epidemic control (95%) among DTG-based recipients, especially with older age and DTG-exposure over three years. Considering the broad HIV diversity observed, these findings are essential for modelling the long-term effectiveness of DTG in RLS and beyond. STUDY REGISTRATION: Register on 10/05/2023; Ethical Clearance Number 2023/022045/CEIRSH/ESS/BC.
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