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Meta-Analysis
. 2023 Jan 17;18(1):e0278670.
doi: 10.1371/journal.pone.0278670. eCollection 2023.

The mother-to-child transmission of HIV-1 and profile of viral reservoirs in pediatric population: A systematic review with meta-analysis of the Cameroonian studies

Aude Christelle Ka'e  1   2 , Alex Durand Nka  1   2 , Bouba Yagai  1   2 , Irénée Domkam Kammogne  3 , Ezechiel Ngoufack Jagni Semengue  1   2 , Aubin Joseph Nanfack  1 , Celine Nkenfou  1   4 , Michel Carlos Tommo Tchouaket  1   5 , Desire Takou  1 , Samuel Martin Sosso  1 , Nadine Fainguem  1   2 , Aissatou Abba  1 , Willy Pabo  1   6 , Nelly Kamgaing  1 , Edith Temgoua  7 , Boris Tchounga  8 , Patrice Tchendjou  8 , Suzie Tetang  9 , Anne Esther Njom Nlend  10 , Francesca Ceccherini-Silberstein  2 , Maria Mercedes Santoro  2 , Joseph Fokam  1   6
Affiliations
Meta-Analysis

The mother-to-child transmission of HIV-1 and profile of viral reservoirs in pediatric population: A systematic review with meta-analysis of the Cameroonian studies

Aude Christelle Ka'e et al. PLoS One. .

Abstract

Background: The mother-to-child transmission of HIV-1 (MTCT) remains on the major route of HIV-transmission among pediatric populations in Africa. Though a prevention of MTCT (PMTCT) high-priority country, data on the MTCT burdens in Cameroon remains fragmented.

Objective: We sought to assess the pooled MTCT rate, its risk-factors, and to characterize viral reservoirs of infected-children in Cameroon.

Methods: All relevant observational cohort and cross-sectional studies conducted in Cameroon were searched from PubMed, African Journals Online, Google scholar, ScienceDirect and academic medical education databases. Heterogeneity and publication bias were respectively assessed by the I2 statistic and the Egger/funnel plot test. Meta-analysis was performed using the random effects model. MTCT rate >5% was considered as "high". This review was registered in the Prospero database, CRD42021224497.

Results: We included a total of 29 studies and analyzed 46 684 children born from HIV-positive mothers. The overall rate of MTCT was 7.00% (95% CI = 6.07-8.51). According to regions, the highest burden was in Adamaoua-region (17.51% [95% CI:14.21-21.07]) with only one study found. PMTCT option-B+ resulted in about 25% reduction of MTCT (8.97% [95% CI: 8.71-9.24] without option-B+ versus 2.88% [95% CI: 5.03-9.34] with option-B+). Regarding risk-factors, MTCT was significantly associated with the absence of PMTCT-interventions both in children (OR:5.40 [95% CI: 2.58-11.27]) and mothers (OR: 3.59 [95% CI: 2.15-5.99]). Regarding viral reservoirs, a pro-viral DNA mean of 3.34±1.05 log10/mL was observed among 5/57 children and archived HIV drug resistance mutations were identified in pro-viral DNA marker among 21/79 infected-children.

Conclusion: In spite of the dropdown in MTCT following option-B+ implementation, MTCT remains high in Cameroon, with substantial disparities across regions. Thus, in this era of option-B+, achieving MTCT elimination requires interventions in northern-Cameroon. The variation in pro-viral load in infected-children underlines the relevance of characterizing viral reservoirs for possible infection control in tropical settings.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of the study selection process.
Fig 2
Fig 2. Funnel plot for publication bias.
Fig 3
Fig 3. Forest plot of the prevalence of MTCT.
Fig 4
Fig 4. Forest plot of MTCT in the ten regions of Cameroon.
The number of participants obtained in this forest plot depend on the studies that reported the region of sampling.
Fig 5
Fig 5. Pooled vertical transmission rate of HIV in Cameroon.
The figure was conceived and adapted by the authors of this review; the base layer of the map was downloaded from http://viewer.nationalmap.gov/viewer/.
Fig 6
Fig 6. Forest plot of the prevalence of MTCT according to the demographic area.
Fig 7
Fig 7. Forest plot of the prevalence of the MTCT according to gender.
Fig 8
Fig 8. Forest plot of the prevalence of the MTCT according to study design.
Fig 9
Fig 9. Association between MTCT of HIV and prevention of mother-to-child transmission intervention.
See this image and copyright information in PMC

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