Virological outcomes and treatment retention in North Vietnam amidst transition to social insurance-based HIV services and dolutegravir-based regimens

Abstract

Vietnam has been experiencing the transition from donor-based to social insurance-based antiretroviral therapy (ART), the COVID-19 pandemic, and expansion of dolutegravir (DTG) use. We assessed virological outcomes, care retention, and effectiveness and tolerability of switching to DTG-containing regimen among people living with HIV (PLHIV) during these changes. PLHIV with suppressed HIV viral load (HIV-VL) who were receiving ART at 11 facilities in North Vietnam were enrolled in a prospective cohort from December 2019 through September 2021 and followed up until March 2023. This cohort of 2,233 PLHIV on ART maintained viral suppression rates (HIV-VL < 50 copies/mL) of > 90% and care retention rates of > 87% throughout the study period. Incidence of viremia (HIV-VL ≥ 200 copies/mL) was 3.2/100 person-years during follow-up. Only 32 (1.4%) PLHIV had any drug resistance mutations; no DTG-associated mutation was observed. Of 1,891 who switched to DTG-containing regimens, 292 (15.4%) discontinued DTG, most commonly owing to DTG stockout (80.8%). Average weight gain was greater in the first measurement after switching than in subsequent measurements. In conclusion, successful maintenance of virologic outcomes of ART and high treatment retention were observed amid various social and clinical changes in Vietnam. These real-world data support the national rollout of DTG.