High risk of virologic failure among HIV-infected children and adolescents routinely followed-up in Littoral region of Cameroon

Abstract

Virological response to antiretroviral therapy (ART) remains a challenge for HIV-infected children and adolescents due to non-optimization of pediatric ART for resource-limited settings. In this study, we aimed to investigate factors associated with virologic failure (VF) in HIV-infected-children and adolescents on ART in Cameroon. A prospective patient-based cohort study was conducted among HIV-infected children (0–9 years) and adolescents (10–19 years) followed-up between November 2018 and October 2019 in 38 healthcare centers located in the Littoral region of Cameroon. The 1st viral load (VL) was assessed after 6 months of ART initiation and the 2nd VL between 3 and 6 six months later in patients with VL ≥1000 copies/ml in accordance with the national algorithm using Abbott Real-Time HIV-1 Viral Load Assay. Multivariate analyses were performed to identify the determinants of higher risk of VF. Of 1,029 HIV-infected children and adolescents (393 children and 636 adolescents), 801 (77.8%) cumulatively presented with VL <1000 copies/mL within 12 months on ART. Adolescents were more likely to have VF than children (24.5% vs 18.3%, OR: 1.39; 95%CI: 1.00–1.93; p = 0.047). Patients followed-up in decentralized care units were significantly more likely to have VF compared to those attending the accredited treatment centers (26.1% vs 16.6%, OR: 1.88, 95%CI: 1.37–2.58; p<0.001). Our findings show a high rate of VL suppression (VLS, 77.8%) among HIV-infected children and adolescents, albeit lower than the established target of 90%. Being adolescent and patients followed in the decentralized care units are high risk factors for VF, thereby necessitating routine therapeutic education of patients and guardians in resource limited countries to improve VLS.

Prevalence and factors associated with viral non‐suppression in people living with HIV receiving antiretroviral therapy in sub‐Saharan Africa: A systematic review and meta‐analysis

“…Of the included studies, 15 were cross‐sectional, 10 were cohort, five were nested studies in clinical trials and two were case‐control (Table 1). The majority (29/32) of the studies 10,22,23,25–43,45–47,49–52 used a viral load threshold of ≥1000 copies/mL to define VNS. Bhardwaj et al.…”

Evaluation of HIV-1 DNA levels among adolescents living with perinatally acquired HIV-1 in Yaounde, Cameroon: A contribution to paediatric HIV cure research in Sub-Saharan Africa

“… 15 It has been shown that difficulties experienced in achieving virological success during adolescence may impact reservoir size and clinical outcomes. 16 It is worth noting that despite the high burden of paediatric HIV-1 infection in SSA, there still persists a gap in data concerning the quantitative characterization of HIV-1 DNA in reservoirs, especially in the Central African sub-region which is known for its high genetic diversity of HIV-1. 17 , 18 Most of studies reporting data on the quantitative profile of HIV-1 reservoirs on the SSA paediatric populations were conducted in Southern African countries and were focusing on very early treated infants.…”