High viral suppression with TLD at Bamenda Regional Hospital despite a narrow real-world cohort
A retrospective study from Bamenda Regional Hospital in Cameroon adds real-world evidence to the expanding body of data supporting tenofovir/lamivudine/dolutegravir, or TLD, for routine HIV care. Among adults living with HIV-1 who were highly adherent and free of recorded comorbidities, viral suppression remained strikingly high at both 6 and 12 months after starting dolutegravir-based combination antiretroviral therapy.
The findings matter because dolutegravir has become the anchor of modern first-line treatment in many settings precisely where durable suppression is most difficult to sustain. Resistance, treatment fatigue, toxicity from older regimens, and gaps in follow-up all interfere with long-term control. A regimen that can hold viral load down in routine care, not just in tightly controlled trials, is the kind of evidence program managers and clinicians watch closely.
At 6 months, 150 of 157 participants were suppressed, a rate of 95.5%. By 12 months, suppression rose to 156 of 157, or 99.4%. Only one participant had confirmed virologic failure and was switched to a second-line regimen. In a cohort already filtered for strong adherence and the absence of recorded comorbidity, those numbers suggest that once patients stay on therapy and attend follow-up, dolutegravir-based treatment can maintain strong virologic control over at least the first year.
One event changed the entire 12-month endpoint picture.
Who was included and why the cohort was so selective
The analysis reviewed medical records of adults aged over 18 years who attended the HIV Treatment Centre and started dolutegravir-based cART between January 2020 and May 2021. Eligibility required at least 95% adherence by pill count, no recorded comorbidities, and enough follow-up time to reach 12 months before the data collection window closed in May 2022. Of 368 records screened, 157 met criteria and had viral load data available at both 6 and 12 months.
Most participants, 99.4%, were receiving TLD. A very small fraction, 0.6%, were on abacavir/lamivudine/dolutegravir. The study included both ART-naïve patients started on dolutegravir-based first-line therapy and ART-experienced patients switched after the 2019 WHO recommendation. That mix reflects real clinic practice in a setting where national policy and patient histories often intersect at the same treatment desk.
The design also explains the caution needed when reading the results. This was a single-centre retrospective study, not a randomized comparison. The population was deliberately narrow: adherent, comorbidity-free adults with complete follow-up and viral load data. Those choices sharpen internal consistency, but they also limit how far the findings can be extended to broader routine care, where adherence is less uniform and chronic illness is common.
Virologic control stayed high in both treatment-naïve and treatment-experienced adults
The primary endpoint was virologic suppression, defined as viral load below 1000 copies/mL. That threshold is operationally important in many HIV programs because it tracks the point at which transmission risk, treatment continuity, and resistance surveillance begin to diverge clinically.
In this cohort, suppression was already high at week 24 and became even more complete by week 48. The study does not provide a breakdown of suppression by all subgroups in a way that supports strong causal claims, but the overall pattern is consistent with the pharmacologic strengths of dolutegravir: a high barrier to resistance, potent antiviral activity, and compatibility with simplified first-line regimens. In the context of good adherence, those features create a regimen with little room for viral rebound.
No baseline factor examined — sex, age, marital status, education, smoking, WHO clinical stage, treatment status, or HIV duration — showed a significant association with 6-month suppression. With only seven unsuppressed participants at 6 months, those null findings should be read as a function of limited statistical power, not as proof that baseline characteristics are irrelevant.
Alcohol use at baseline was associated with higher 6-month suppression, with a risk ratio of 1.14 and a 95% confidence interval of 1.02 to 1.28. The Fisher’s exact p value was 0.002. The association is biologically and clinically difficult to interpret in isolation, especially without adjustment for confounding, and the small number of events makes it unsuitable as a practice-changing signal. It is best treated as a hypothesis for later work rather than a conclusion about behavior and HIV control.
Weight gain appeared, but the study could not parse its clinical meaning
By 12 months, the median weight change in the study population was +2.0 kg, with an interquartile range of 0 to 4 kg. Weight gain has become an increasingly discussed issue in people starting integrase inhibitor-based regimens, especially dolutegravir-containing therapy. The biological explanation remains unsettled, but the clinical signal is familiar enough that many HIV clinics now monitor body weight alongside viral load and tolerability.
In this study, the weight data are descriptive rather than explanatory. There is no signal here of obesity-related harm, metabolic compromise, or treatment discontinuation tied to weight change. Even so, a modest rise in weight over the first year of therapy can be relevant at the bedside, particularly when baseline nutritional status, food insecurity, or prior illness severity are part of the clinical picture.
The single participant who experienced confirmed virologic failure illustrates the practical boundary of any suppressive regimen: even highly effective therapy cannot fully overcome adherence lapses, pharmacologic failure, or resistance in every case. A switch to second-line treatment after failure is a reminder that sustained monitoring still matters after the first prescription is written.
What this Cameroon experience can and cannot tell clinicians
This report strengthens the descriptive case for dolutegravir-based antiretroviral therapy in a Central African routine-care setting. The high suppression rates at 6 and 12 months are reassuring, especially in a cohort that included both ART-naïve and treatment-experienced adults. The consistency of suppression across time points suggests that, in patients who remain engaged in care and take medication reliably, TLD can perform very well outside a trial setting.
Yet the study’s own structure limits interpretation. The sample was small, the setting was single-centre, follow-up was relatively short, and the eligibility criteria excluded many of the clinical realities that complicate HIV care. No adjustment for confounding was possible for the 6-month comparisons, and the 12-month analysis was not subjected to formal statistical testing. Those constraints prevent any claim that TLD is superior to other regimens or that the outcomes would look the same in a broader, less selected population.
The most useful reading of the study is narrower: in adherent adults without documented comorbidity, TLD produced durable viral suppression over 12 months in routine care at Bamenda Regional Hospital. Future work will need larger samples, longer follow-up, and more representative populations before those outcomes can be generalized across Central Africa or used to compare regimen performance head to head.