Rates of Viral Non-Suppression and Acquired HIV-1 Drug Resistance Emergence among Children during the Sociopolitical Crisis in the Northwest Region of Cameroon: A Call for Improved Monitoring Strategies
Authors: Ayokanmi Mobereade , Fokam Joseph , Tchidjou Hyppolite Kuekou , Chenwi Collins Ambe , Hortense Gonsu Kamga , Kamgaing Nelly , Takou Desire , Beloumou Grace Angong , Semengue Ezechiel , Djupsa Sandrine , Nka Alex Durand , Teto Georges , Dambaya Beatrice , Sosso Samuel Martin , Santoro Maria Mercedes , Ceccherini-Silberstein Francesca , Awoh Rogers Ajeh , Ekane Gregory Edie Halle , Bissek Anne-Cecile Zoung Kanyi , Ndembi Nicaise , Colizzi Vittorio , Mbanya Dora , Perno Carlo-Federico , Ndjolo Alexis 
Published: October 2024

Background:
Virological failure (VF) among children remains concerning, with high risks of
HIV drug resistance (HIVDR) emergence and increased disease progression. Therefore, monitoring of viral
non-suppression and emerging HIVDR is crucial, especially in the frame of sociopolitical unrest.

Objective:
The study sought to determine the prevalence of VF and evaluate the acquired HIVDR and viral
genetic diversity among children in the northwest region of Cameroon during the ongoing sociopolitical
crisis.

Methods:
A cross-sectional facility-based study was conducted among HIV-infected children aged ≤18
years, receiving antiretroviral therapy (ART) in urban and rural settings of Northwest Cameroon, from
November 2017 through May 2018. Viral load (VL) was done using the Abbott m2000RealTime. Unsuppressed
VL was defined as viral load ≥1,000 copies/ml. HIVDR testing was performed by sequencing of
HIV-1 protease-reverse transcriptase at the Chantal Biya International Reference Center (CIRCB) using
an in-house protocol. Drug resistance mutations (DRM) were interpreted using Stanford HIVdbv8.5 and
phylogeny using MEGAv.6. Data were compared between urban and rural areas with p<0.05 considered
statistically significant.

Results:
A total of 363 children were recruited, average age of 12 years (urban) and 8 years (rural). VL
coverage was 100% in the urban setting and 77% in the rural setting. Overall, VF was 40.5% (39%
[130/332] in the urban setting and 41% (13/31) in the rural setting; p=0.45). Overall, viral undetectability
(defined as VL<40 copies/ml) was 45.5% (46% (urban) and 45% (rural); p=0.47). Among those experiencing
confirmed virological failure and who were successfully sequenced (n=35), the overall rate of
HIVDR was 100% (35/35). By drug class, HIVDR rates were 97.1% (34/35) for non-nucleoside reverse
transcriptase inhibitors (NNRTIs), 97.1% (34/35) for NRTIs and 17.1% (6/35) for protease inhibitors
(22.7% (5/22) in the urban setting and 7.7% [1/13] in the rural setting). CRF02_AG was the most prevalent
viral clade (75%), followed by other recombinants (09_cpx, 11_cpx, 13_cpx, 22_01A1, 37_cpx) and
pure subtypes (A1, F2, G, H).

Conclusion:
In this population of children and adolescents living with HIV in a context of socio-political
instability in the North-West region of Cameroon, rates of viral non-suppression are high, and accompanied
by HIVDR selection. Our suggests the need for a more differentiated care of these CAHIV, especially
those in these regions faced with significant socio-economic and health impacts due to the ongoing
crisis.