Abstract
Introduction
Cambodia started to transition its first-line ART regimen from non-TLD (mostly TDF+3TC+EFV) to tenofovir, lamivudine, and dolutegravir (TLD) in January 2019. Little is known about the current extent and the effects of this transition on PLHIV in Cambodia. This study examined ART records to describe TLD and non-TLD coverage and its effects on HIV viral load (VL) weight and body mass index (BMI) among PLHIV initiating ART.
Methods
The analysis was purely based on the national ART database records stored at the National Center for HIV/AIDS, Dermatology and STIs (NCHADS) of 8,810 patients aged ? 15 who newly initiated ART (naïve patient) stored in the database from January 2019 to June 2021 across 25 provinces in 69 clinical sites nationwide. The TLD versus non-TLD prescriptions were disaggregated by province, by quarter, and by demographics as well as the effects of ART regimens on VL weight and body mass index (BMI).
Results
Of the 8,810 PLHIV newly initiated on ART, 66.2% were from four provinces: Banteay Meanchey, Battambang, Siem Reap and Phnom Penh. A total of 68.7% were male, and 77.5% were ? 25 years of age. The TLD regimen for newly initiated PLHIV increased from 25% in the first quarter (Q1) of 2019 to 91% in Q4 of 2020. Then, it continued to increase up to 93% in Q2 of 2021. Of 76% of PLHIV who initiated TLD as a first-line regimen (men: 82.2%, women: 61.9%), the highest TLD prescription rates were seen in five provinces: Kampot (88%), Siem Reap (84%), Kampong Thom (84%), Phnom Penh (82%) and Kampong Chhnang (81%). The VL suppression rates in the first 6 months after ART initiation were 95.1% and 89.7% among TLD and non-TLD patients, respectively. The weight gains at the time of their first VL evaluation were 60% for TLD patients and 49% for non-TLD patients. The BMI increased to 50% for TLD and 42% for non-TLD.
Conclusion
In this study, the TLD coverage as the first-line regimen was relatively high. TLD has demonstrated its effectiveness in PLHIV care and treatment in terms of its efficacy, tolerability, limited side effects, and viral suppression. Naïve patients starting with the TLD regimen increase the speed of achieving higher viral suppression in comparison with non-TLD. The TLD regimen is more efficient than the non-TLD regimen. Additionally, PLHIV under the TLD regimen significantly gain weight and BMI more than PLHIV on the non-TLD regimen. This study supports the national program of starting all ARV-naïve patients with TLD.