Published May 16, 2025
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Confirmed virological failure following enhanced adherence counseling among virally unsuppressed children and adolescents on dolutegravir-based versus other regimens: Evidence from a cohort analysis in Cameroon.

Creators

  • 1. Departmental Faculty of Medicine and Surgery, Saint Camillus International University of Health Sciences, Rome, Italy.
  • 2. Virology Laboratory, Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon.
  • 3. Pediatric Department, Essos Health Centre, National Social Welfare Centre, Yaoundé, Cameroon.
  • 4. Central Technical Group, National AIDS Control Committee (NACC), Ministry of Public Health, Yaoundé, Cameroon.
  • 5. Division of Diseases, HIV/AIDS Department, Epidemic and Pandemic Control, Ministry of Public Health, Yaoundé, Cameroon.
  • 6. Laboratory of Virology, Research Center on Emerging and Re-Emerging Diseases (CREMER),Yaoundé, Cameroon.
  • 7. Centre for Research and Military Health (CRESAR), Ministry of Defense, Yaoundé, Cameroon.
  • 8. Retrovirology Laboratory, Laquintinie Hospital, Douala, Cameroon.
  • 9. Molecular Biology Laboratory, Fondation Sociale Suisse, Pette Hospital, Pette, Cameroon.
  • 10. HIV/AIDS Treatment Centre, Mother-Child Centre, Chantal BIYA Foundation, Yaoundé, Cameroon.
  • 11. HIV/AIDS Treatment Centre, Cité Verte District Hospital, Yaoundé, Cameroon.
  • 12. Global Funds Subvention Coordination Unit, Ministry of Public Health, Yaoundé, Cameroon.
  • 13. Division of Operational Research in Health, Ministry of Public Health, Yaoundé, Cameroon.
  • 14. Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
  • 15. Global Funds Project Management Unit, Republic of Chad, N'djamena, Chad.
  • 16. Institute for Biological Systems (ISB), National Research Council, Rome, Italy.
  • 17. Consiglio Nazionale delle Ricerche
  • 18. Laboratoire de Lutte contre les Grandes Endémies (LAGET), Centre Hospitalo-Universitaire le Bon Samaritain, N'djamena, Chad.
  • 19. Faculty of Health Sciences, University of Buea, Buea, Cameroon.
  • 20. Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
  • 21. University of Rome Tor Vergata
  • 22. Division of Surveillance and Disease Intelligence, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia.
  • 23. Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD.
  • 24. UNESCO Board of Multidisciplinary Biotechnology, University of Rome "Tor Vergata", Rome, Italy.
  • 25. Microbiology and Diagnostic Immunology Unit, Bambino Gesù' Children Hospital, IRCCS, Rome, Italy.
  • 26. Scientific Institute for Research, Hospitalization and Healthcare

Description

Achieving and maintaining viral suppression (VS) in pediatric populations remain suboptimal in low- and middle-income countries (LMICs), calling for the optimized management approaches. We compared the rate of confirmed virological failure (cVF) and associated factors among virally non-suppressed (VnS) children and adolescents after enhanced adherence counseling (EAC) on dolutegravir-based versus other regimens. A multicentre and prospective cohort study was conducted among ART-experienced children (<10 years) and adolescents (10-19 years) with VnS followed-up for confirmatory viral load (VL) after EAC. cVF was defined as 2 consecutive VL ≥ 1000 copies/mL after ≥6 months of ART and EAC. Overall, 250 individuals with VnS were enrolled, median [IQR] age was 12 (11-13) and median duration on ART was 57 (48-67) months. According to ART-regimens, 48.4% received DTG-based regimens (TDF/3TC/DTG: 32.8%; ABC/3TC + DTG: 15.6%). Overall, cVF rate was 39.2% (95% CI: 33.3-45.3), with a longer duration on ART among cVF-group (68 [60-79] months) versus VS-group (48 [45-61]), P = .026. According to ART-regimen, cVF rate was 29.3% in those receiving TDF/3TC/DTG versus 43.5% for ABC/3TC + ATV/r/LPV/r and 25.6% for ABC/3TC + DTG, P = .007. Regarding anchor-drugs, cVF with DTG, EFV and ATV/r/LPV/r was 28.1%, 48.4% and 49.2%, respectively, P = .007. Interestingly, 13.2% of participants with VS had detectable low-level viremia (400-999 copies/mL), with 5.8%, 7.7% and 12.9% being observed in those receiving DTG, ATV/r/LPV/r, and EFV/NVP-based regimen, respectively, P = .013. Only anchor-drug was found to be a predictor of cVF. Compared to those receiving DTG-based regimens, ART based on ATV/LPV/r (aOR [95% CI]: 0.298 [0.132-0.72], P = .004) or EFV/NVP (aOR [95% CI]: 0.401 [0.163-0.983], P = .046) was significantly less likely to achieve VS. About 40% of Cameroonian children/adolescents with VnS experience cVF, which is indicative that EAC significantly contributes to viral re-suppression (60%), especially with DTG-based regimens. Thus, implementing a strategy that couples DTG-transition with EAC-interventions would contribute substantially to efforts in eliminating pediatric AIDS in LMICs.
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