Romo, Matthew L.Edwards, Jessie K.Semeere, Aggrey S.Musick, Beverly S.Urassa, MarkOdhiambo, FrancescaDiero, LameckKasozi, CharlesMurenzi, GadLelo, PatriciaWyka, KatarzynaKelvin, Elizabeth A.Sohn, Annette H.Wools-Kaloustian, Kara K.Nash, DenisInternational epidemiology Databases to Evaluate AIDS (IeDEA)2023-10-092023-10-092022Romo ML, Edwards JK, Semeere AS, et al. Viral Load Status Before Switching to Dolutegravir-Containing Antiretroviral Therapy and Associations With Human Immunodeficiency Virus Treatment Outcomes in Sub-Saharan Africa. Clin Infect Dis. 2022;75(4):630-637. doi:10.1093/cid/ciab1006https://hdl.handle.net/1805/36217Background: Dolutegravir is being rolled out globally as part of preferred antiretroviral therapy (ART) regimens, including among treatment-experienced patients. The role of viral load (VL) testing before switching patients already on ART to a dolutegravir-containing regimen is less clear in real-world settings. Methods: We included patients from the International epidemiology Databases to Evaluate AIDS consortium who switched from a nevirapine- or efavirenz-containing regimen to one with dolutegravir. We used multivariable cause-specific hazards regression to estimate the association of the most recent VL test in the 12 months before switching with subsequent outcomes. Results: We included 36 393 patients at 37 sites in 5 countries (Democratic Republic of the Congo, Kenya, Rwanda, Tanzania, Uganda) who switched to dolutegravir from July 2017 through February 2020, with a median follow-up of approximately 11 months. Compared with those who switched with a VL <200 copies/mL, patients without a recent VL test or with a preswitch VL ≥1000 copies/mL had significantly increased hazards of an incident VL ≥1000 copies/mL (adjusted hazard ratio [aHR], 2.89; 95% confidence interval [CI], 1.99-4.19 and aHR, 6.60; 95% CI, 4.36-9.99, respectively) and pulmonary tuberculosis or a World Health Organization clinical stage 4 event (aHR, 4.78; 95% CI, 2.77-8.24 and aHR, 13.97; 95% CI, 6.62-29.50, respectively). Conclusions: A VL test before switching to dolutegravir may help identify patients who need additional clinical monitoring and/or adherence support. Further surveillance of patients who switched to dolutegravir with an unknown or unsuppressed VL is needed.en-USPublisher PolicyHIV integrase inhibitorsAntiretroviral agentsClinical decision-makingPrognosisViral loadArticle