Title:Rates of Viral Non-Suppression and Acquired HIV-1 Drug Resistance Emergence among Children during the Sociopolitical Crisis in the Northwest Region of Cameroon: A Call for Improved Monitoring Strategies
Volume: 22
Issue: 5
Author(s): Mobereade Ayokanmi*, Joseph Fokam*, Hyppolite Kuekou Tchidjou, Collins Ambe Chenwi, Gonsu Kamga Hortense, Nelly Kamgaing, Desire Takou, Grace Angong Beloumou, Ezechiel Semengue, Sandrine Djupsa, Alex Durand Nka, Georges Teto, Beatrice Dambaya, Samuel Martin Sosso, Maria Mercedes Santoro, Francesca Ceccherini-Silberstein, Rogers Ajeh Awoh, Gregory Edie Halle Ekane, Anne-Cecile Zoung Kanyi Bissek, Nicaise Ndembi, Vittorio Colizzi, Dora Mbanya, Carlo-Federico Perno and Alexis Ndjolo
Affiliation:
- Department of Virology, Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management,
Yaoundé, Cameroon
- Department of Programs, Association for Reproductive and Family Health, , Ibadan,
Oyo State, Nigeria
- Department of Virology, Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management,
Yaoundé, Cameroon
- Department of Haematology, Faculty of Health Sciences, University of Buea, Buea, Cameroon
- National HIV Drug Resistance Group, Ministry of Public Health, Yaoundé, Cameroon
- Department of Haematology,
Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
Keywords:
Paediatric, HIV drug resistance, viral load, drug resistance, virological failure, antiretroviral therapy.
Abstract:
Background: Virological failure (VF) among children remains concerning, with high risks of HIV
drug resistance (HIVDR) emergence and increased disease progression. Therefore, monitoring of viral non-suppression
and emerging HIVDR is crucial, especially in the frame of sociopolitical unrest.
Objective: The study sought to determine the prevalence of VF and evaluate the acquired HIVDR and viral genetic
diversity among children in the Northwest region of Cameroon during the ongoing sociopolitical crisis.
Methods: A cross-sectional facility-based study was conducted among HIV-infected children aged ≤18 years,
receiving antiretroviral therapy (ART) in urban and rural settings of Northwest Cameroon, from November
2017 through May 2018. Viral load (VL) was done using the Abbott m2000RealTime. Unsuppressed VL was
defined as viral load ≥1,000 copies/ml. HIVDR testing was performed by sequencing of HIV-1 protease-reverse
transcriptase at the Chantal Biya International Reference Center (CIRCB) using an in-house protocol. Drug resistance
mutations (DRM) were interpreted using Stanford HIVdbv8.5 and phylogeny using MEGAv.6. Data
were compared between urban and rural areas with p<0.05 considered statistically significant.
Results: A total of 363 children were recruited, average age of 12 years (urban) and 8 years (rural). VL coverage
was 100% in the urban setting and 77% in the rural setting. Overall, VF was 40.5% (39% [130/332] in the
urban setting and 41% (13/31) in the rural setting; p=0.45). Overall, viral undetectability (defined as VL<40
copies/ml) was 45.5% (46% (urban) and 45% (rural); p=0.47). Among those experiencing confirmed virological
failure and who were successfully sequenced (n=35), the overall rate of HIVDR was 100% (35/35). By drug
class, HIVDR rates were 97.1% (34/35) for non-nucleoside reverse transcriptase inhibitors (NNRTIs), 97.1%
(34/35) for NRTIs and 17.1% (6/35) for protease inhibitors (22.7% (5/22) in the urban setting and 7.7% [1/13]
in the rural setting). CRF02_AG was the most prevalent viral clade (75%), followed by other recombinants
(09_cpx, 11_cpx, 13_cpx, 22_01A1, 37_cpx) and pure subtypes (A1, F2, G, H).
Conclusion: In this population of children and adolescents living with HIV in a context of socio-political instability
in the North-West region of Cameroon, rates of viral non-suppression are high, and accompanied by HIVDR
selection. Our findings suggest the need for a more differentiated care of these CAHIV, especially those in
these regions faced with significant socio-economic and health impacts due to the ongoing crisis.
