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Title
Viral suppression in the era of transition to Dolutegravir-based therapy in Cameroon: children at high risk of virological failure
Presenter
Alex Durand Nka
Authors
A.D. Nka1, J. Fokam2, F.Y. Mamgue Dzukam3, J. Gabisa Efakika4, Y. Bouba5, M.C. Tommo Tchouaket2, A.C. Ka’e2, E. Ngoufack Jagni Semengue2, S. Moudourou2, N. Fainguem2, S.C. Billong6, A.-C. Zoung-Kanyi Bissek7, V. Colizzi2, C.-F. Perno8, S.M. Sosso2, A. Ndjolo2
Institutions
1Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Virology, Yaounde, Cameroon, 2Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon, 3University of Buea, Yaounde, Cameroon, 4Centre Pasteur Cameroun, Yaounde, Cameroon, 5Central Technical Group, National AIDS Control Committee, Yaounde, Cameroon, 6National HIV Drug Resistance Working Group, Yaounde, Cameroon, 7Division of Health Operational Research, Ministry of Public Health, Yaounde, Cameroon, 8Bambino Gesu Pediatric Hospital, Rome, Italy

BACKGROUND: Transition to Dolutegravir (DTG)-based antiretroviral therapy (ART) may improve virological response (VR) in sub-Saharan Africa. Because VR may vary by age, understanding ART response across age-range may inform interventions on ART program. Our objective was to compare VR between children, adolescents and adults in the Cameroonian context.
METHODS: A comparative study was conducted from January 2021 to May 2022 amongst ART-experienced patients received at the Chantal BIYA International Reference Centre for HIV/AIDS prevention and management in Yaoundé-Cameroon for plasma viral load (PVL) monitoring. PVL was measured on Abbott m2000RT-PCR as per manufacturer’s instructions. VR was defined as viral suppression (VL< 1000 copies/mL) and viral undetectability (VL< 50 copies/mL). Data were analyzed by SPSS v.20.0, with p< 0.05 considered as significant.
RESULTS: A total of 9034 patients, 72.8% female, were enrolled (8565 adults, 227 adolescents, 222 children); 1618 were on NNRTI-based, 299 on PI-based, and 7118 on DTG based ART (82 children, 198 adolescents, 6824 adults). Median (IQR) duration on ART was 24 (12-72) months. Overall, VS was 89.9% (95% CI: 89.2-90.5) and viral undetectability was 75.8% (95% CI 74.8-76.7). Following ART-regimen, VS on NNRTI-based, PI/r-based, and DTG-based therapy was respectively 86.5%, 60.2% and 91.8%, p<0.0001. Following ART-duration, VS was respectively 90.4% (M12), 87.8% (M24), 89.1% (M36), and 90.0% (= M48), p<0.0001. Following gender, VS was 91.0% (females) versus 87.1% (males), p<0.0001. Following age, VS was 65.2% (children), 74.4% (adolescents), and 90.9% (adults), p<0.0001. Following multivariate analysis, predictors of VS were adults, females, TLD regimens, and cART duration >24 months (p<0.05).
CONCLUSIONS: In Cameroon, ART response indicates encouraging rates of VS (about 9/10) and viral undetectability (about 3/4), driven essentially by access to TLD-based regimens in the adult populations. However, ART response was very poor in children, underscoring the need for scaling-up pediatric DTG-based regimens.