Viral Monitoring and Prevalence of Viral Failure in HIV-1 Infected Children under First Line Antiretroviral Therapy during the First 60 Months of Treatment in Yaoundé, Cameroon: A Serial Cross Sectional Analysis

Abstract

Objective: The objective was to measure the prevalence of viral failure (VF) in HIV-1-infected children on first-line antiretroviral therapy (ART) in routine practice. Methods: Serial cross sectional analysis of viral load (VL) in HIV-1 infected children on first-line ART for ≥24 weeks was done. VL was measured by Real-Time-Polymerase chain reaction (biocentrics). Samples were collected at 6, 12, 24, 36, 48, 60 months of treatment. Main measurement: Virological failure (VF) defined by a one-off VL > 1000 copies/ml. Results: 375 children aged ≤16 years on first-line-ART were included. Median age at ART start was 4.2 years and ≥50% have started ART ≤3 rd birthday. A total of 717 measurements of VL were collected. VF was rated between 18% and 26% from 6-60 months (mean 20.2%), 95% IC [13.1-27.3] at the threshold of 1000 copies/ml, not too different at the threshold of 400 copies/ml, 21%-30% (mean 23.9%), 95% IC [16.3-31.5], p = 0.9. Conclusion: In Yaounde, almost 20% of children on first-line of adherent-ART can experiment VF while improving immune status urging improvement of adherence.

Virological and immunological failure of HAART and associated risk factors among adults and adolescents in the Tigray region of Northern Ethiopia

“…Unlike to our result, higher virological failure was reported from Kenya 23.7% [ 45 ] and 24.6% [ 46 ], Liberia 47% [ 29 ], Zimbabwe 30.6% [ 47 ], Tanzania 57.1% [ 30 ], 32% [ 48 ], Cameroon 20.6% [ 49 ], Ghana 16.7% [ 50 ], Togo 51.6% [ 51 ], Colombia 20.9% [ 18 ], India 69.6% [ 38 ] and Peru 24% [ 52 ]. This difference may be due to lower treatment adherence compared with our study [ 48 , 52 ].…”

Magnitude of virologic failure and associated factors among adult patients on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia, 2018

“…In agreement with previous studies [32,[35][36][37][38][39][40][41][42], the current study found baseline non-working functional status, low CD4 cell count, advanced WHO clinical stage, and presence of opportunistic infections leads to ART virological failure. Despite this fact, these risk factors are highly interconnected, CD4 cell count is the backbone of immunity construction that helps the human body to protect from the disease and can prevent HIV replication [44].…”

“…This finding was comparable with studies conducted in Uganda 11% [26], and it was also in line with studies done in Ethiopia; Tigray (11.5%) [35], Gondar (11.8%) [32] and Bahir Dar Feleg Hiwot (10.7%) [30]. However, the result of the current study, higher virological failure was reported studies done in Kenya 23.7% [22] and Cameron (23.2%) [23], 20.6% [37] and Swaziland 16% [28].…”

“…This difference may be due to differences in definition of virological failure, where plasma viral load 400 copies/ml was used as cut-off point for virological failure [22,23,37]. Differences in the inclusion criteria used might also be another possible explanation, i.e., the study participants included in those studies were clinically or immunologically failed and had lower median age (9.5 years old) [37,38].…”

“…This might be due to the fact that those worker patients may have better income that in turn creates opportunity to get better care and support. This finding could also be explained as patients who were unable to work might be in their advanced WHO stage of the disease aggravated from greater immunosuppression (low CD4 count) [5,13,44] or they might be depressed, feel hopelessness which might in turn lead to poor drug adherence then virological or in general treatment failure [37][38][39][40]. .…”