ArticleSouthern African journal of HIV medicine2026
Early outcomes of South African children with persistent viral non-suppression following switch to dolutegravir-based antiretroviral therapy.
Article in Southern African journal of HIV medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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.
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