Viral Load Profile at the Efavirenz-Dolutegravir Switch: A Case Study of the Center of Excellence for the Care of People Living with HIV/AIDS at the University of Lubumbashi, Democratic Republic of Congo
Introduction: Optimizing antiretroviral regimens is a major challenge for achieving sustained virological suppression in people living with HIV in sub-Saharan Africa. Faced with increasing resistance to non-nucleoside reverse transcriptase inhibitors, particularly efavirenz (EFV), the WHO has recommended dolutegravir (DTG) as first-line treatment since 2019. However, real-world data remain limited in the Democratic Republic of Congo. This study aimed to compare virological suppression with EFV and DTG at the HIV/AIDS Center of Excellence at the University of Lubumbashi. Methods: A retrospective longitudinal observational study was conducted from 2019 to 2024 in 4617 adults living with HIV who received clinical and virological follow-up. Sociodemographic, clinical, and biological data were extracted from electronic health records. Virological suppression was defined as a viral load < 1000 copies/mL after ≥6 months of treatment. Comparisons were performed using the chi-square test and odds ratios (95% CI). Results: Virological suppression was significantly higher with DTG (40.3%) than with EFV (32.7%). DTG was associated with an increased probability of suppression (OR = 2.47; 95% CI [2.11 - 2.88]; p < 0.001). Death and loss-to-follow-up rates were comparable between groups. However, 45% of patients did not have viral load measurements, limiting the complete evaluation of the results. Conclusion: These results confirm the virological superiority of DTG in real-world conditions and support its adoption as a first-line regimen in the DRC. Strengthening virological monitoring and patient retention remains essential to maximize its programmatic impact.
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