Clinical Effectiveness of Dolutegravir-based Antiretroviral Therapy and its Determinants in Persons Living with HIV at a Kenyan Referral Hospital

Abstract

Dolutegravir is widely used for HIV treatment as a first line drug. Though proven to be efficacious in other settings, its clinical effectiveness in resource-constrained settings is not yet confirmed. To determine the clinical effectiveness of dolutegravir regimens and associated factors in adults living with HIV at the Kenyatta National Hospital, a cross-sectional study was conducted at the HIV clinic using data abstracted from randomly sampled patient files. Descriptive and regression analysis were done using STATA version-13 at an α of < 0.05. Most of the 154 participants enrolled were females (95, 61.7%). The mean age was 45.2 (SD + 10.6) years. Viral load suppression was 92.6% and 95.5% at 6 and 12 months respectively. The TDF/3TC/DTG regimen (aOR = 21.607, 95% CI 1.118, 417.591) gave better odds of viral suppression at six months. Prevalence of opportunistic infections significantly decreased after dolutegravir initiation with bacterial pneumonia (6, 3.9%) being most common. Being treatment-experienced (aOR = 0.066, 95% CI 0.005, 0.886) resulted in lower odds of opportunistic infections after dolutegravir initiation. Adverse drug reactions to dolutegravir were infrequent though headache (11, 7.1%), weight-gain (3, 1.9%), and insomnia (2, 1.3%) were reported. Males (aOR = 0.222, 95% CI 0.061, 0.814) had lower odds of having adverse drug reactions. Dolutegravir-based regimens are clinically effective and well-tolerated with minimal adverse drug reactions.