Alarming rates of virological failure and HIV-1 drug resistance amongst adolescents living with perinatal HIV in both urban and rural settings: evidence from the EDCTP READY-study in Cameroon

doi:10.1111/hiv.13095

. 2021 Aug;22(7):567-580.

doi: 10.1111/hiv.13095. Epub 2021 Mar 31.

Alarming rates of virological failure and HIV-1 drug resistance amongst adolescents living with perinatal HIV in both urban and rural settings: evidence from the EDCTP READY-study in Cameroon

J Fokam^{1

2

3

4

5}, D Takou¹, D Njume^{1

5}, W Pabo^{1

6}, M M Santoro⁷, A-E Njom Nlend⁸, G Beloumou¹, S Sosso¹, S Moudourou¹, G Teto¹, B Dambaya¹, S Djupsa¹, S Tetang Ndiang⁸, F N Ateba⁹, S C Billong^{2

3

10}, C Kamta¹¹, L Bala¹², V Lambo¹³, V Tala^{1

2}, C Chenwi Ambe^{1

2}, M L Mpouel^{1

2}, G Cappelli¹⁴, F Cham^{4

15}, R Ndip⁶, L Mbuagbaw⁵, P Koki Ndombo^{2

9}, F Ceccherini-Silberstein⁷, V Colizzi^{1

7}, C-F Perno^{1

4

16}, A Ndjolo^{1

2}

Affiliations

¹ Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon.
² Faculty of Medicine and Biomedical Sciences (FMSB), University of Yaoundé I, Yaoundé, Cameroon.
³ National HIV Drug Resistance Working Group (HIVDRWG), Ministry of Public Health, Yaoundé, Cameroon.
⁴ World Health Organisation Africa Multilingual Expert Laboratory Trained (MELT) group, Brazzaville, Congo.
⁵ Faculty of Health Sciences (FHS), University of Buea, Buea, Cameroon.
⁶ Faculty of Science (FS), University of Buea, Buea, Cameroon.
⁷ University of Rome Tor Vergata (UTV), Rome, Italy.
⁸ National Social Welfare Hospital (NSWFH), Yaoundé, Cameroon.
⁹ Mother-Child Centre of the Chantal BIYA's foundation (MCC-CBF), Yaoundé, Cameroon.
¹⁰ Central Technical Group, National AIDS Control Committee (NACC), Yaoundé, Cameroon.
¹¹ Mfou District Hospital (MDH), Mfou, Cameroon.
¹² Mbalmayo District Hospital (MDH), Mbalmayo, Cameroon.
¹³ Nkomo Medical Center (NMC), Nkomo, Cameroon.
¹⁴ National Research Council, Rome, Italy.
¹⁵ Global Funds for the fight against AIDS, Malaria and Tuberculosis, Geneva, Switzerland.
¹⁶ University of Milan (UM), Milan, Italy.

PMID: 33792134
DOI: 10.1111/hiv.13095

Free article

Alarming rates of virological failure and HIV-1 drug resistance amongst adolescents living with perinatal HIV in both urban and rural settings: evidence from the EDCTP READY-study in Cameroon

J Fokam et al. HIV Med. 2021 Aug.

Free article

. 2021 Aug;22(7):567-580.

doi: 10.1111/hiv.13095. Epub 2021 Mar 31.

Authors

Affiliations

¹ Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon.
² Faculty of Medicine and Biomedical Sciences (FMSB), University of Yaoundé I, Yaoundé, Cameroon.
³ National HIV Drug Resistance Working Group (HIVDRWG), Ministry of Public Health, Yaoundé, Cameroon.
⁴ World Health Organisation Africa Multilingual Expert Laboratory Trained (MELT) group, Brazzaville, Congo.
⁵ Faculty of Health Sciences (FHS), University of Buea, Buea, Cameroon.
⁶ Faculty of Science (FS), University of Buea, Buea, Cameroon.
⁷ University of Rome Tor Vergata (UTV), Rome, Italy.
⁸ National Social Welfare Hospital (NSWFH), Yaoundé, Cameroon.
⁹ Mother-Child Centre of the Chantal BIYA's foundation (MCC-CBF), Yaoundé, Cameroon.
¹⁰ Central Technical Group, National AIDS Control Committee (NACC), Yaoundé, Cameroon.
¹¹ Mfou District Hospital (MDH), Mfou, Cameroon.
¹² Mbalmayo District Hospital (MDH), Mbalmayo, Cameroon.
¹³ Nkomo Medical Center (NMC), Nkomo, Cameroon.
¹⁴ National Research Council, Rome, Italy.
¹⁵ Global Funds for the fight against AIDS, Malaria and Tuberculosis, Geneva, Switzerland.
¹⁶ University of Milan (UM), Milan, Italy.

PMID: 33792134
DOI: 10.1111/hiv.13095

Abstract

Objectives: Adolescents living with perinatal HIV infection (ALPHI) experience persistently high mortality rates, particularly in resource-limited settings. It is therefore clinically important for us to understand the therapeutic response, acquired HIV drug resistance (HIVDR) and associated factors among ALPHI, according to geographical location.

Methods: A study was conducted among consenting ALPHI in two urban and two rural health facilities in the Centre Region of Cameroon. World Health Organization (WHO) clinical staging, self-reported adherence, HIVDR early warning indicators (EWIs), immunological status (CD4 count) and plasma viral load (VL) were assessed. For those experiencing virological failure (VF, VL ≥ 1000 copies/mL), HIVDR testing was performed and interpreted using the Stanford HIV Drug Resistance Database v.8.9-1.

Results: Of the 270 participants, most were on nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens (61.7% urban vs. 82.2% rural), and about one-third were poorly adherent (30.1% vs. 35.1%). Clinical failure rates (WHO-stage III/IV) in both settings were < 15%. In urban settings, the immunological failure (IF) rate (CD₄ < 250 cells/μL) was 15.8%, statistically associated with late adolescence, female gender and poor adherence. The VF rate was 34.2%, statistically associated with poor adherence and NNRTI-based antiretroviral therapy. In the rural context, the IF rate was 26.9% and the VF rate was 52.7%, both statistically associated with advanced clinical stages. HIVDR rate was over 90% in both settings. EWIs were delayed drug pick-up, drug stock-outs and suboptimal viral suppression.

Conclusions: Poor adherence, late adolescent age, female gender and advanced clinical staging worsen IF. The VF rate is high and consistent with the presence of HIVDR in both settings, driven by poor adherence, NNRTI-based regimen and advanced clinical staging.

Keywords: CD4 count; Cameroon; HIV drug resistance; adherence; adolescents; antiretroviral therapy; viral load.

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References

1. UNAIDS. Fact sheet 2016 Available at http://www.unaids.org/en/resources/factsheet (Geneva, Switzerland) (accessed 12 august 2020).
1. Boerma RS, Bunupuradah T, Dow D et al. Multicentre analysis of second-line antiretroviral treatment in HIV-infected children: adolescents at high risk of failure. J Int AIDS Soc 2017; 20: 21930
1. Fokam J, Billong SC, Jogue F et al. Immuno-virological response and associated factors amongst HIV-1 vertically infected adolescents in Yaoundé-Cameroon. PLoS One 2017; 12: e0187566.
1. WHO | HIV/AIDS / WHO. Available at http://www.who.int/gho/hiv/en/ (accessed 6 December 2018).
1. Mbanya D, Sama M, Tchounwou P. Current status of HIV/AIDS in Cameroon: how effective are control strategies? Int J Environ Res Public Health 2008; 5: 378-383.

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[1] UNAIDS. Fact sheet 2016 Available at http://www.unaids.org/en/resources/factsheet (Geneva, Switzerland) (accessed 12 august 2020).

[2] UNAIDS. Fact sheet 2016 Available at http://www.unaids.org/en/resources/factsheet (Geneva, Switzerland) (accessed 12 august 2020).

[3] Boerma RS, Bunupuradah T, Dow D et al. Multicentre analysis of second-line antiretroviral treatment in HIV-infected children: adolescents at high risk of failure. J Int AIDS Soc 2017; 20: 21930

[4] Boerma RS, Bunupuradah T, Dow D et al. Multicentre analysis of second-line antiretroviral treatment in HIV-infected children: adolescents at high risk of failure. J Int AIDS Soc 2017; 20: 21930

[5] Fokam J, Billong SC, Jogue F et al. Immuno-virological response and associated factors amongst HIV-1 vertically infected adolescents in Yaoundé-Cameroon. PLoS One 2017; 12: e0187566.

[6] Fokam J, Billong SC, Jogue F et al. Immuno-virological response and associated factors amongst HIV-1 vertically infected adolescents in Yaoundé-Cameroon. PLoS One 2017; 12: e0187566.

[7] WHO | HIV/AIDS / WHO. Available at http://www.who.int/gho/hiv/en/ (accessed 6 December 2018).

[8] WHO | HIV/AIDS / WHO. Available at http://www.who.int/gho/hiv/en/ (accessed 6 December 2018).

[9] Mbanya D, Sama M, Tchounwou P. Current status of HIV/AIDS in Cameroon: how effective are control strategies? Int J Environ Res Public Health 2008; 5: 378-383.

[10] Mbanya D, Sama M, Tchounwou P. Current status of HIV/AIDS in Cameroon: how effective are control strategies? Int J Environ Res Public Health 2008; 5: 378-383.

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Alarming rates of virological failure and HIV-1 drug resistance amongst adolescents living with perinatal HIV in both urban and rural settings: evidence from the EDCTP READY-study in Cameroon

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Alarming rates of virological failure and HIV-1 drug resistance amongst adolescents living with perinatal HIV in both urban and rural settings: evidence from the EDCTP READY-study in Cameroon

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