Comparison of Viral Loads Between Recent DTG-Based and Previous EFV-Based Regimens in HIV Treatment at the ART Center, Provincial Hospital, MIHS, Janakpur, Madhesh Province, Nepal.
Main Article Content
Abstract
Introduction
Dolutegravir (DTG)-based triple therapy is emerging as the preferred approach for both initiating and maintaining HIV treatment over the Efavirenz (EFV)-based regimen in people living with HIV (PLHIV). Study is based on the viral load suppression during three years of treatment at the ART center.
Methods
This analysis is divided into two groups’ namely DTG and EFV-based regimen. There are altogether 224 patients in each regimen before and after the use of Dolutegravir (DTG) regimen for three years from June 1st 2019 to May 30th 2023. Patients virologically assessed for at least 48 weeks in all 3 years (2019, 2020, and 2023). on standard ART. Out of 224 patients, 63 patients all those who had viral load more than 20 copies/ml in 2019 are selected for the analysis.
Results
A total of 63 patients were included in this analysis. Participants were on ART for 48 weeks on EFV-based regimen in 2019 before using DTG based regimen in 2020. In 2019, the mean VL was 11,784.6 copies/ml, and by 2020, the mean VL had decreased to 6,442.0 copies/ml. In 2023, the viral load decreased achieving 0 to 20 copies/ml, although a small subset continued to exhibit persistent viremia. Also, correlation between age and viral load showed a gradual increase in the negative correlation over time, suggesting that younger individuals may experience higher viral loads, mainly due to lower adherence to ART or differences in immune response.
Also, tests showed significant reductions in viral load from 2019 and 2023 with p value less than 0.01and age groups in 2023 showed no significant impact on viral load. Regression analysis indicated that neither age nor sex significantly influenced viral load levels in 2023.
Conclusions
This study insights into the effectiveness of ART in controlling between 2019 and 2023. The negative correlation between age and viral load highlights the importance of targeted interventions for younger individuals to improve adherence and long-term outcomes. Test shows significant reductions in viral load across the years. However, persistent viremia in a subset of individuals indicates the need for continued monitoring and interventions to address treatment failure and resistance. Further research should explore the factors contributing to persistent high viral loads, especially in younger populations.