Genotypic resistance testing improves antiretroviral treatment outcomes in a cohort of adolescents in Cameroon: Implications in the dolutegravir‑era

Authors

  • Willy Le Roi Togna Pabo Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé; Faculty of Medicine and Biomedical Sciences, Yaoundé; Faculty of Science, University of Buea, Buea https://orcid.org/0000-0002-5194-6715
  • Debimeh Njume Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé; Faculty of Medicine and Biomedical Sciences, Yaoundé; Faculty of Health Sciences, University of Buea, Buea
  • Roland Ndip Ndip Faculty of Science, University of Buea, Buea
  • Desiré Takou Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
  • Maria-Mercedes Santoro University of Rome Tor Vergata, Rome
  • Collins Chenwi Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé; Faculty of Medicine and Biomedical Sciences, Yaoundé
  • Grace Beloumou Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
  • Ezechiel Ngoufack Jagni Semengue University of Rome Tor Vergata, Rome, Italy; Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé; Evangelic University of Cameroon, Bandjoun
  • Alex Durand Nka University of Rome Tor Vergata, Rome, Italy; Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé; Evangelic University of Cameroon, Bandjoun
  • Aude Christelle Ka'e University of Rome Tor Vergata, Rome, Italy; Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
  • Georges Teto Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
  • Beatrice Dambaya Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
  • Sandrine Djupsa Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
  • Raymond Babila Nyasa Faculty of Science, University of Buea, Buea
  • Davy Hyacinthe Gouissi Anguechia Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé; Faculty of Medicine and Biomedical Sciences, Yaoundé
  • Cedric Kamta Mfou District Hospital, Mfou
  • Lionel Bala Mbalmayo District Hospital, Mbalmayo
  • Virginie Lambo Nkomo Integrated Health Center, Nkomo
  • Samuel Martin Sosso Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management, Yaoundé
  • Vittorio Colizzi University of Rome Tor Vergata, Rome, Italy; Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé; Evangelic University of Cameroon, Bandjoun
  • Carlo Federico Perno Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon; University of Rome Tor Vergata, Rome; Bambino Gesu Pediatric Hospital, Rome
  • Joseph Fokam Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé; Faculty of Medicine and Biomedical Sciences, Yaoundé; Faculty of Health Sciences, University of Buea, Buea; National HIV Drug Resistance Group, Ministry of Public Health, Yaoundé https://orcid.org/0000-0002-1501-2763
  • Alexis Ndjolo Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé; Faculty of Medicine and Biomedical Sciences, Yaoundé

DOI:

https://doi.org/10.4081/jphia.2023.2612

Keywords:

HIV care, viral load, antiretroviral therapy, HIV drug resistance, adolescents, Cameroon

Abstract

Background: Acquired drug resistance (ADR) is common among adolescents living with perinatal HIV (APHI) in sub-Saharan Africa (SSA). Personalized management has the potential to improve pediatric antiretroviral therapy (ART), even in the presence of long-term treatment and HIV-1 subtype diversity. Objective: We sought to evaluate the effect of HIV-1 mutational profiling on immuno-virological response and ADR among APHI. Methods: A cohort-study was conducted from 2018-2020 among 311 APHI receiving ART in Cameroon. Clinical, immunological and virological responses were measured at enrolment (T1), 6-months (T2) and 12-months (T3). Immunological failure (IF: CD4<250 cells/mm3), VF (viremia≥1000 copies/ml), and ADR were analyzed, with p<0.05 considered significant. Results: Mean age was 15(±3) years; male-female ratio was 1:1; median [IQR] ART-duration was 36[21-81] months. At T1, T2, and T3 respectively, adherence-level was 66.4%, 58.3% and 66.5%; 14 viral clades were found, driven by CRF02_AG (58.6%); ADR-mutations favored increased switch to second-line ART (16.1%, 31.2%, and 41.9%, p<0.0001). From T1-T3 respectively, there were declining rates of IF (25.5%, 18.9%, and 9.83, p<0.0001), VF (39.7%, 39.9%, and 28.2%, p=0.007), and HIVDR (96.4%, 91.7%, and 85.0%, p=0.099). Predictors of ADR were being on first-line ART (p=0.045), high viremia at enrolment (AOR=12.56, p=0.059), and IF (AOR=5.86, p=0.010). Of note, optimized ART guided by mutational profile (AOR=0.05, p=0.002) was protective. Moreover, full Tenofovir+Lamivudine+Dolutegravir efficacy was predicted in 77% and 62% of APHI respectively after first- and second-line failure. Conclusions: Among APHI in this SSA setting, viral mutational profiling prompts the use of optimized Dolutegravir-based ART regimens, leading to improved immuno-virological response and declining ADR burdens. Thus, implementing personalized HIV medicine in this vulnerable population would substantially improve ART response and the achievement of the 95-95-95 goals in these underserved populations.

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Published

22-11-2023

How to Cite

Togna Pabo, W. L. R., Njume, D., Ndip Ndip, R., Takou, D., Santoro, M.-M., Chenwi, C., Beloumou, G., Ngoufack Jagni Semengue, E., Nka, A. D., Ka’e, A. C., Teto, G., Dambaya, B., Djupsa, S., Babila Nyasa, R., Gouissi Anguechia, D. H., Kamta, C., Bala, L., Lambo, V., Sosso, S. M., Colizzi, V., Perno, C. F., Fokam, J., & Ndjolo, A. (2023). Genotypic resistance testing improves antiretroviral treatment outcomes in a cohort of adolescents in Cameroon: Implications in the dolutegravir‑era. Journal of Public Health in Africa, 14(10). https://doi.org/10.4081/jphia.2023.2612

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