HIV treatment has significantly improved with the introduction of potent antiretroviral therapy (ART), particularly dolutegravir (DTG) -based regimens. With suboptimal adherence reported in resource-limited settings (RLS), real-word evidence on DTG-effectiveness within ART clinics is limited. This study assessed virological response, drug resistance profiling and HIV-1 diversity among ART recipients at the Yaoundé Central Hospital (YCH), Cameroon. A facility-based study was conducted at YCH from May-2023 to February-2025. HIV plasma viral load (PVL) was measured by RT-PCR. Viral suppression (VS) was defined as PVL 1 for DTG-sparing throughout). Furthermore, from those virally unsuppressed in 2025, 9% (39/432) were lost-to-follow-up, 22% (94/432) were transfer-out to other health facilities and 65% (232/432) re-suppressed after enhanced adherence counselling; leaving us with 17 participants eligible for GRT (PVL≥1000copies/mL). GRT was successful for 70. 5% (12/17) and DRMs detected in 83% (10/12), including major DRMs to protease inhibitors (17%), to nucleoside reverse transcriptase inhibitors (75%) and to non-nucleoside reverse transcriptase inhibitors (83%). CRF02AG (75%) was the prevailing HIV-1 group M clade, followed by A3, D, and CRF18cpx (each 8. 3%). These real-life data reveal viral suppression rates closer to the epidemic control (95%) among DTG-based recipients, especially with older age and DTG-exposure over three years. Considering the broad HIV diversity observed, these findings are essential for modelling the long-term effectiveness of DTG in RLS and beyond. Register on 10/05/2023; Ethical Clearance Number 2023/022045/CEIRSH/ESS/BC.
Tadenfok et al. (Mon,) studied this question.