Evaluation of Viral Suppression in Paediatric Populations: Implications for the Transition to Dolutegravir-Based Regimens in Cameroon: The CIPHER-ADOLA Study

Mortality in children accounts for 15% of all AIDS-related deaths globally, with a higher burden among Cameroonian children (25%), likely driven by poor virological response. We sought to evaluate viral suppression (VS) and its determinants in a nationally representative paediatric and young adult p...

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Published in:	Biomedicines Vol. 12; no. 9; p. 2083
Main Authors:	Fokam, Joseph, Bouba, Yagai, Ajeh, Rogers Awoh, Guebiapsi, Dominik Tameza, Essamba, Suzane, Zeh Meka, Albert Franck, Lifanda, Ebiama, Ada, Rose Armelle, Yakouba, Liman, Mbengono, Nancy Barbara, Djomo, Audrey Raissa Dzaddi, Tetang, Suzie Ndiang, Sosso, Samuel Martin, Babodo, Jocelyne Carmen, Ambomo, Olivia Francette Ndomo, Temgoua, Edith Michele, Medouane, Caroline, Atsinkou, Sabine Ndejo, Mvogo, Justin Leonel, Onana, Roger Martin, Anoubissi, Jean de Dieu, Ketchaji, Alice, Nka, Alex Durand, Gouissi, Davy-Hyacinthe Anguechia, Ka'e, Aude Christelle, Fainguem, Nadine Nguendjoung, Kamgaing, Rachel Simo, Takou, Désiré, Tchouaket, Michel Carlos Tommo, Semengue, Ezechiel Ngoufack Jagni, Atsama, Marie Amougou, Nwobegahay, Julius, Vuchas, Comfort, Nsimen, Anna Nya, Bille, Bertrand Eyoum, Gatchuessi, Sandra Kenmegne, Ateba, Francis Ndongo, Kesseng, Daniel, Billong, Serge Clotaire, Armenia, Daniele, Santoro, Maria Mercedes, Ceccherini-Silberstein, Francesca, Koki, Paul Ndombo, Hamsatou, Hadja Cherif, Colizzi, Vittorio, Ndjolo, Alexis, Perno, Carlo-Federico, Zoung-Kanyi Bissek, Anne-Cecile
Format:	Journal Article
Language:	English
Published:	Switzerland MDPI AG 12-09-2024 MDPI
Subjects:	Acquired immune deficiency syndrome Adolescents AIDS Analysis Antiretroviral therapy Art, Modern Children Darunavir DTG-based regimen Efavirenz HIV Human immunodeficiency virus Laboratories Lopinavir low-level viremia Modernism (Art) Nevirapine Pediatrics Population studies Rilpivirine Ritonavir viral suppression Young adults Cameroon United States > US DTG-based regimen low-level viremia Cameroon elimination of paediatric AIDS adolescents children young adults viral suppression
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Summary:	Mortality in children accounts for 15% of all AIDS-related deaths globally, with a higher burden among Cameroonian children (25%), likely driven by poor virological response. We sought to evaluate viral suppression (VS) and its determinants in a nationally representative paediatric and young adult population receiving antiretroviral therapy (ART). A cross-sectional and multicentric study was conducted among Cameroonian children (<10 years), adolescents (10-19 years) and young adults (20-24 years). Data were collected from the databases of nine reference laboratories from December 2023 to March 2024. A conditional backward stepwise regression model was built to assess the predictors of VS, defined as a viral load (VL) <1000 HIV-RNA copies/mL. Overall, 7558 individuals (females: 73.2%) were analysed. Regarding the ART regimen, 17% of children, 80% of adolescents and 83% of young adults transitioned to dolutegravir (DTG)-based regimens. Overall VS was 82.3%, with 67.3% (<10 years), 80.5% (10-19 years) and 86.5% (20-24 years), and < 0.001. VS was 85.1% on a DTG-based regimen versus 80.0% on efavirenz/nevirapine and 65.6% on lopinavir/ritonavir or atazanavir/ritonavir. VS was higher in females versus males (85.8% versus 78.2%, < 0.001). The VS rate remained stable around 85% at 12 and 24 months but dropped to about 80% at 36 months after ART initiation, < 0.009. Independent predictors of non-VS were younger age, longer ART duration (>36 months), backbone drug (non-TDF/3TC) and anchor drug (non-DTG based). In this Cameroonian paediatric population with varying levels of transition to DTG, overall VS remains below the 95% targets. Predictors of non-VS are younger age, non-TDF/3TC- and non-DTG-based regimens. Thus, efforts toward eliminating paediatric AIDS should prioritise the transition to a DTG-based regimen in this new ART era.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 These authors contributed equally to this work. Co-first authors.
ISSN:	2227-9059 2227-9059
DOI:	10.3390/biomedicines12092083