Children and adolescents in low- and middle-income countries living with HIV showed a reduced viral load after treatment with dolutegravir (DTG), based on data from more than 28,000 individuals presented at the Conference on Retroviruses and Opportunistic Infections (CROI) 2026 Annual Meeting.

DTG, a once-daily integrase inhibitor, has demonstrated effectiveness in treating HIV in adults and children. Although DTG is a first-line therapy in the US, many low- and middle-income countries have not had access to it until recently, said David J. Cennimo, MD, AAHIVS, assistant professor of medicine-pediatrics infectious disease at Rutgers New Jersey Medical School, Newark, New Jersey, who was not involved in the study.

“It is always important to conduct studies in diverse areas with differing resources and support systems,” Cennimo said.

To provide information on outcomes after DTG in underserved populations, Sophie Desmonde, PhD, of the French National Institute of Health and Medical Research, and colleagues reviewed data from a multiregional cohort of 28,718 children and adolescents living with HIV who started or transitioned to DTG-based antiretroviral therapy (ART) between 2018 and 2024 in clinics in West, East, Central, and Southern Africa, the Asia-Pacific Region, and the Caribbean, as part of the IeDEA consortium.

The researchers assessed viral load at baseline and at 6, 12, and 24 months after starting DTG. Virologic status was characterized as suppressed (< 200 copies/mL), low-level viremia (200-999 copies/mL), or unsuppressed (≥ 1000 copies/mL). They used logistic regression to compare the three groups and identify factors associated with viremia for individuals with 12-month viral load data. The median age of the study population was 13.8 years, and 53% were female, with a mean duration of ART of 5.9 years. The median follow-up period after starting DTG was 26 months, and 24% were lost to follow-up.

At baseline, 76% were suppressed, 7% had low-level viremia, and 17% were unsuppressed. At 12 months, data were available for 20,281 individuals, and 11% had an elevated viral load. After controlling for factors including sex, age, region, previous ART, and switching of nucleoside reverse transcriptase inhibitors (NRTIs) at the time of transition to DTG, baseline viral load predicted outcomes. Baseline low-level viremia was associated with low-level viremia at 12 months (odds ratio [OR], 1.51), and individuals with baseline unsuppressed and baseline unknown viral loads were significantly more likely to have unsuppressed viral loads at 12 months (OR, 2.86 and 1.46, respectively). Similarly, of the 15,584 individuals with data at 24 months, 11% had an elevated viral load.

Overall, individuals who were ART-naive, re-initiators, and transitioning from protease inhibitors vs non-NRTIs were more likely to be unsuppressed vs suppressed, the researchers noted.

Most children and adolescents living with HIV achieved suppressed viral load after 12 months of DTG, the researchers said. “However, those with elevated baseline viral load and prior treatment history remain at higher risk for elevated viral load at 12 months,” they noted. “Special attention should be given to children and adolescents living with HIV who are initiating DTG with a detectable viral load to clarify the factors contributing to virologic failure,” they concluded.

Data Support DTG as Switch or New Start

The effectiveness data were not surprising because DTG is known to be a safe and effective drug, Cennimo told Medscape Medical News. Some of the data likely reflect the “real-world” nature of the study, he said. “While the mean follow-up time was good, 24% were lost to follow-up. While this may not necessarily mean the participants were no longer receiving care, it could serve to highlight the importance of continued engagement and need for care retention,” Cennimo explained. “Also, those who entered the study with unsuppressed viremia had a higher risk of failing to reach undetectable, which may be a marker of medication adherence,” he noted.

Although large numbers of patients in the current study were lost to follow-up, the results support using the best drugs available because they work, Cennimo said. “More long-term follow-up (more years in care under this treatment regimen) could strengthen the findings,” he said.

The study received no outside funding. The researchers and Cennimo disclosed having no financial conflicts of interest.