RESUMEN
BACKGROUND: Treatment failure is common among children and adolescents with HIV. Antiretroviral therapy (ART) containing dolutegravir has recently been rolled out across Africa, though long-term real-world data in paediatric populations are lacking. Here, we report treatment outcomes among children and adolescents in Lesotho who transitioned from nonnucleoside reverse transcriptase inhibitor (NNRTI)-based to dolutegravir-based ART through 2 years' follow-up. METHODS: Data were derived from two open cohort studies in Lesotho. Children and adolescents aged less than 18âyears who transitioned from NNRTI-based to dolutegravir-based ART at least 18âmonths before data closure were included. We report viral load results less than 12âmonths before, 12 (window: 6-17) months after, and 24 (window: 18-29) months after transition to dolutegravir. Associations of pretransition demographic and clinical factors with 24-month viraemia were assessed through multivariable logistic regression. RESULTS: Among 2126 included individuals, 1100 (51.7%) were female individuals, median age at transition to dolutegravir was 14.0âyears [interquartile range (IQR) 11.5-15.8], and median time taking ART at transition was 7.6âyears (IQR 4.4-10.6). Among those with a viral load result at the respective time points, viral suppression to less than 50âcopies/ml was achieved by 1635 of 1973 (82.9%) less than 12âmonths before, 1846 of 2012 (91.8%) 12âmonths after, and 1725 of 1904 (90.6%) 24âmonths after transition to dolutegravir. Pretransition viraemia was associated with viraemia at 24âmonths, though more than 80% of individuals with pretransition viraemia achieved resuppression to less than 50âcopies/ml at 24âmonths. CONCLUSION: The proportion of children and adolescents with viral suppression increased after transition to dolutegravir, though further progress is needed to reach global targets.