High HIV viral suppression among adults receiving WHO-recommended first-line dolutegravir-based antiretroviral therapy in low- and middle-income countries: a systematic review and meta-analysis of programmatic evidence
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Published version
Author(s)
Type
Journal Article
Abstract
Background
This systematic review and meta-analysis assessed viral suppression among adults receiving WHO-recommended first-line dolutegravir-based ART in programmatic settings in low- and middle-income countries (LMICs).
Methods
A systematic search of Ovid MEDLINE, Embase, and major HIV conferences (IAS, AIDS, and CROI) from January 2019 to September 2024 identified cohort and cross-sectional studies reporting viral suppression among adults receiving WHO-recommended first-line dolutegravir-based ART in LMICs. Studies with follow-ups ≤ 4 months or using non-WHO-recommended regimens were excluded. Pooled estimates were calculated using random-effects meta-analysis. Sensitivity analyses excluded outliers. Subgroup analyses distinguished adults initiating versus transitioning to dolutegravir-based ART. Both on-treatment and intention-to-treat outcomes were assessed.
Results
Twenty-two studies (n = 47 to 50,742) from 13 countries were included. On-treatment pooled viral suppression was 95% (95% CI: 91–97%, I²= 96%) at six months, 96% (94–98%, I² = 97%) at 12 months, and 98% (96–99%, I² = 94%) at 24 months. Sensitivity analysis removing outliers decreased heterogeneity and slightly lowered the 6‑month estimate (to 94%), with negligible change at 12 months. At 6 months, viral suppression was higher in those transitioning than initiating ART (98% vs. 94%, p < 0.01), with similar rates at 12 months (97%, p = 0.67). The pooled intention-to-treat 12-month viral suppression rate was 89% (82–93%, I² = 95%), with no significant difference by ART status (initiating 86% vs. transitioning 91%, p = 0.44).
Conclusion
Adults retained in care receiving WHO-recommended first-line dolutegravir-based ART achieved viral suppression rates of ≥ 95% up to two years. These findings align with the UNAIDS 95% suppression target and reinforce the role of dolutegravir-based regimens in ending HIV as a public health threat.
Trial registration: CRD42024557769.
This systematic review and meta-analysis assessed viral suppression among adults receiving WHO-recommended first-line dolutegravir-based ART in programmatic settings in low- and middle-income countries (LMICs).
Methods
A systematic search of Ovid MEDLINE, Embase, and major HIV conferences (IAS, AIDS, and CROI) from January 2019 to September 2024 identified cohort and cross-sectional studies reporting viral suppression among adults receiving WHO-recommended first-line dolutegravir-based ART in LMICs. Studies with follow-ups ≤ 4 months or using non-WHO-recommended regimens were excluded. Pooled estimates were calculated using random-effects meta-analysis. Sensitivity analyses excluded outliers. Subgroup analyses distinguished adults initiating versus transitioning to dolutegravir-based ART. Both on-treatment and intention-to-treat outcomes were assessed.
Results
Twenty-two studies (n = 47 to 50,742) from 13 countries were included. On-treatment pooled viral suppression was 95% (95% CI: 91–97%, I²= 96%) at six months, 96% (94–98%, I² = 97%) at 12 months, and 98% (96–99%, I² = 94%) at 24 months. Sensitivity analysis removing outliers decreased heterogeneity and slightly lowered the 6‑month estimate (to 94%), with negligible change at 12 months. At 6 months, viral suppression was higher in those transitioning than initiating ART (98% vs. 94%, p < 0.01), with similar rates at 12 months (97%, p = 0.67). The pooled intention-to-treat 12-month viral suppression rate was 89% (82–93%, I² = 95%), with no significant difference by ART status (initiating 86% vs. transitioning 91%, p = 0.44).
Conclusion
Adults retained in care receiving WHO-recommended first-line dolutegravir-based ART achieved viral suppression rates of ≥ 95% up to two years. These findings align with the UNAIDS 95% suppression target and reinforce the role of dolutegravir-based regimens in ending HIV as a public health threat.
Trial registration: CRD42024557769.
Date Issued
2025-09-26
Date Acceptance
2025-08-11
Citation
AIDS Research and Therapy, 2025, 22
ISSN
1742-6405
Publisher
BMC
Journal / Book Title
AIDS Research and Therapy
Volume
22
Copyright Statement
© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
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Publication Status
Published
Article Number
91
Date Publish Online
2025-09-26