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

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...

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Published in:	HIV medicine Vol. 22; no. 7; pp. 567 - 580
Main Authors:	Fokam, J, Takou, D, Njume, D, Pabo, W, Santoro, MM, Njom Nlend, A‐E, Beloumou, G, Sosso, S, Moudourou, S, Teto, G, Dambaya, B, Djupsa, S, Tetang Ndiang, S, Ateba, FN, Billong, SC, Kamta, C, Bala, L, Lambo, V, Tala, V, Chenwi Ambe, C, Mpouel, ML, Cappelli, G, Cham, F, Ndip, R, Mbuagbaw, L, Koki Ndombo, P, Ceccherini‐Silberstein, F, Colizzi, V, Perno, C‐F, Ndjolo, A
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-08-2021
Subjects:	adherence Adolescent Adolescents Anti-HIV Agents - pharmacology Anti-HIV Agents - therapeutic use Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Cameroon Cameroon - epidemiology CD4 antigen CD4 count Drug resistance Drug Resistance, Viral Failure rates Female Gender Geographical distribution Geographical locations Health care facilities HIV HIV drug resistance HIV Infections - drug therapy HIV-1 Human immunodeficiency virus Humans Immunology Non-nucleoside reverse transcriptase inhibitors Resistance factors RNA-directed DNA polymerase Teenagers Urban areas Urban environments Viral Load Cameroon Cameroon viral load adolescents adherence antiretroviral therapy CD4 count HIV drug resistance
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Summary:	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.
Bibliography:	These authors contributed equally to this work. Senior authors of this work. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1464-2662 1468-1293
DOI:	10.1111/hiv.13095