The Botswana Beat Cohort Study: Favorable Outcomes for Dolutegravir-Based Regimens

In June 2016, Botswana became the first country in Africa to employ a dolutegravir-based regimen (DBR) as part of a “treat all” strategy. Now, investigators are reporting 12-month outcomes from the Botswana Epidemiological ART Treatment Cohort Study (BEAT), an observational research cohort tracking virologic and clinical outcomes of people living with HIV who are beginning DBR.

The findings were presented as a late-breaker poster at the Annual Conference on Retroviruses and Opportunistic Infections (CROI 2019) on March 6, 2019.

Investigators sought to analyze the outcomes for treatment-naïve patients, highly treatment-experienced patients, and patients switched to a DBR. Armed with data from the Botswana Ministry of Health and Wellness electronic records, national HIV and laboratory databases from 11 urban and semi-rural facilities, and information obtained from patient files and clinic registeries, the research team ultimately examined health information from 2257 people living with HIV (1523 previously treatment-naïve, 638 treatment switches, and 140 highly treatment-experienced patients).

The median age of people included in the cohort study was 39 years and 63% were women.

Among individuals who began a regimen of dolutegravir within the past year, viral load suppression was high overall. Two treatment-naïve individuals and 1 highly treatment-experienced person experienced adverse events (severe itching and a rash) severe enough to require intervention or a switch from DBR.

Seventy-seven deliveries occurred during the study, and no neural tube defects were reported in any of the infants. Eleven of the expecting mothers had begun dolutegravir prior to conception.

Overall, the introduction of dolutegravir-based regimens in Botswana is associated with favorable outcomes, including high rates of viral load suppression and few toxicities at 12 months.

“These findings are reassuring and suggest that the decision to implement ‘Treat All’ and introduce DBRs was an important step to controlling the HIV epidemic in Botswana,” investigators concluded. “Efforts to maintain high retention in care and identify and treat pre-existing opportunistic infections prior to DBR initiation are critical, particularly with the introduction of same-day initiations as part of the Treat All Strategy.”

The poster, “12-Month Outcomes on Dolutegravir-Based Regimens in Botswana: The Beat Cohort Study,” was presented on Wednesday, March 6, 2019, at CROI 2019 in Seattle, Washington.