Viral suppression in the era of transition to dolutegravir-based therapy in Cameroon: Children at high risk of virological failure due to the lowly transition in pediatrics
Authors: Fokam Joseph , Nka Alex Durand , Mamgue Dzukam Flore Yollande , Efakika Gabisa Jeremiah , Bouba Yagai , Tommo Tchouaket Michel Carlos , Ka’e Aude Christelle , Ngoufack Jagni Semengue Ezechiel , Takou Desire , Moudourou Sylvie , Fainguem Nadine , Pabo Willy , Nayang Mundo Rachel Audrey , Kengni Ngueko Aurelie Minelle , Ambe Chenwi Collins , Flore Yimga Junie , Nnomo Zam Marie Krystel , Simo Kamgaing Rachel , Tangimpundu Charlotte , Kamgaing Nelly , Njom-Nlend Anne-Esther , Ndombo Koki Paul , Kesseng Daniel , Ndiang Tetang Suzie , Kembou Etienne , Ebiama Lifanda Lifanda , Pamen Bouba , Ketchaji Alice , Saounde Temgoua Edith , Billong Serge Clotaire , Zoung-Kanyi Bissek Anne-Cecile , Hadja Hamsatou , Halle Edie Gregory , Colizzi Vittorio , Perno Carlo-Federico , Sosso Samuel Martin , Ndjolo Alexis 
Published: May 2023

This study aimed to compare viral suppression (VS) between children, adolescents, and adults in the frame of transition to dolutegravir (DTG)-based antiretroviral therapy (ART) in the Cameroonian context. A comparative cross-sectional study was conducted from January 2021 through May 2022 amongst ART-experienced patients received at the Chantal BIYA International Reference Centre in Yaounde-Cameroon, for viral load (VL) monitoring. VS was defined as VL < 1000 copies/mL and viral undetectability as VL < 50 copies/mL. Chi-square and multivariate binary logistic regression models were used to identify factors associated with VS. Data were analyzed using SPSS v.20.0 (SPSS Inc., Chicago, Illinois), with P < .05 considered significant. A total of 9034 patients (72.2% females) were enrolled. In all, there were 8585 (95.0%) adults, 227 (2.5%) adolescents, and 222 (2.5%) children; 1627 (18.0%) were on non-nucleoside reverse transcriptase-based, 290 (3.2%) on PI-based, and 7117 (78.8%) on DTG-based ART. Of those on DTG-based ART, only 82 (1.2%) were children, 138 (1.9%) adolescents, and 6897 (96.9%) adults. Median (interquartile range) duration on ART was 24 (12–72) months (24 months on Tenofovir + Lamivudine + Dolutegravir [TLD], 36 months on other first lines, and 84 months on protease inhibitors boosted with ritonavir-based regimens). Overall, VS was 89.8% (95% confidence interval: 89.2–90.5) and viral undetectability was 75.7% (95% confidence interval: 74.8–76.7). Based on ART regimen, VS on Non-nucleoside reverse transcriptase-based, protease inhibitors boosted with ritonavir-based, and DTG-based therapy was respectively 86.4%, 59.7%, and 91.8%, P < .0001. Based on ART duration, VS was respectively 51.7% (≤24 months) versus 48.3% (≥25 months), P < .0001. By gender, VS was 90.9% (5929) in females versus 87.0% (2183) in males, P < .0001; by age-range, VS moved from 64.8% (144) in children, 74.4% (169) adolescents, to 90.8% (7799) adults, P < .0001. Following multivariate analysis, VS was associated with adulthood, female gender, TLD regimens, and combination antiretroviral therapy duration > 24 months (P < .05). In Cameroon, ART response indicates encouraging rates of VS (about 9/10) and viral undetectability (about 3/4), driven essentially by access to TLD based regimens. However, ART response was very poor in children, underscoring the need for scaling-up pediatric DTG-based regimens.