PA-352 Detectable low-level viremia among people living with HIV in Cameroon suggests a revised threshold for viral suppression: evidence in the era of dolutegravir-based ART

BackgroundTransitioning to dolutegravir-based therapy in Cameroon has improved viral suppression (VS) rates, known as low-level viremia (LLV) <1000copies/ml. However, there is a growing number of patients experiencing VS with detectable LLV, indicating risk of virological failure. This study aime...

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Published in:	BMJ global health Vol. 8; no. Suppl 10; p. A68
Main Authors:	Nka, Alex Durand, Fokam, Joseph, Chenwi, Collins Ambe, Jeremiah, Efakaki Gabisa, Mamgue Dzukam, Flore Yollande, Bouba, Yagai, Tommo Tchouaket, Michel Carlos, Jagni Semengue, Ezechiel Ngoufack, Takou, Desire, Moudourou, Sylvie, Fainguem, Nadine, Pabo, Willy, Kengni Ngueko, Aurelie Minelle, Yimga, Junie Flore, Nnomo Zam, Krystel Marie, Kamgaing, Rachel, Tangimpundu, Charlotte, Kamgaing, Nelly, Njom-Nlend, Anne-Esther, Ajeh, Rogers, Kembou, Etienne, Lifanda, Lifanda Ebiama, Pamen, Bouba, Ketchaji, Alice, Temgoua, Edith, Billong, Serge Clotaire, Bissek, Anne-Cecile Z-K, Hadja, Hamsatou, Halle, Edie GE, Colizzi, Vittorio, Sosso, Samuel Martin, Ndjolo, Alexis
Format:	Journal Article
Language:	English
Published:	London BMJ Publishing Group Ltd 17-12-2023 BMJ Publishing Group LTD
Subjects:	Abstracts of Poster and e-Poster Presentations Antiretroviral drugs HIV Human immunodeficiency virus Cameroon
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Summary:	BackgroundTransitioning to dolutegravir-based therapy in Cameroon has improved viral suppression (VS) rates, known as low-level viremia (LLV) <1000copies/ml. However, there is a growing number of patients experiencing VS with detectable LLV, indicating risk of virological failure. This study aimed to characterize the distribution of LLV and associated factors in the Cameroonian context.MethodsA laboratory-based study was conducted among treatment-experienced patients monitored for HIV plasma viral load (PVL) from January 2020 through April 2022 at the Chantal BIYA International Reference Centre (CIRCB), Yaoundé-Cameroon. PVL was measured using the Abbott m2000RT-PCR. Among patients with LLV, levels of PVL were stratified into 4 cut-points: <50, 50–200, 201–500, and 501–999 copies/ml, with p<0.05 considered statistically significant.ResultsOverall, 14970 patients were enrolled: 72.5% were female; 14219 adults, 466 adolescents, 285 children. By ART-regimens, 3411 were on NNRTI-based, 505 on PI/r-based and 11054 on DTG-based ART. Median [IQR] duration on ART was 36[27–39] months. Overall VS (<1000 copies/ml) rate was 88.8% (13291/14970) (95% CI: 88.2–89.3), and stratification in this population showed 1.5% (207/13291) with 501–999 copies/ml, 3.3% (445/13291) with 200–500 copies/ml, 10.8% (1439/13291) had 50–200 copies/ml, and 84.2% (11200/13291) with <50 copies/ml, p<0.0001. By ART-regimens, detectable LLV (50–999copies/ml) was 13.9% (1540/11054) with DTG-containing versus 14.1% (551/3916) with other ART-regimens, p=0.81. By age, detectable LLV was 13.8% among adults versus 16.9% mchildren/adolescents, p=0.01. Most importantly, the trend overtime of detectable LLV between 50–200 copies/ml increased significantly from 65.2% (534/819) in 2020, 70.7% (678/958) in 2021 and 72.2% (227/314) in 2022, p=0.001.ConclusionEven though VS rate appears encouraging, there is a significant increasing proportion of patients with detectable LLV in this DTG-era. Of note, LLV with 50–200 copies appears highly predominant, suggesting a revision of threshold for VS at a maximum of 200 copies/ml in resource-limited settings like Cameroon.
Bibliography:	Abstracts of The Eleventh EDCTP Forum, 7–10 November 2023
ISSN:	2059-7908
DOI:	10.1136/bmjgh-2023-EDC.168