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.

Autor: Fokam J; Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon.; Faculty of Medicine and Biomedical Sciences (FMSB), University of Yaoundé I, Yaoundé, Cameroon.; National HIV Drug Resistance Working Group (HIVDRWG), Ministry of Public Health, Yaoundé, Cameroon.; World Health Organisation Africa Multilingual Expert Laboratory Trained (MELT) group, Brazzaville, Congo.; Faculty of Health Sciences (FHS), University of Buea, Buea, Cameroon., Takou D; Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon., Njume D; Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon.; Faculty of Health Sciences (FHS), University of Buea, Buea, Cameroon., Pabo W; Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon.; Faculty of Science (FS), University of Buea, Buea, Cameroon., Santoro MM; University of Rome Tor Vergata (UTV), Rome, Italy., Njom Nlend AE; National Social Welfare Hospital (NSWFH), Yaoundé, Cameroon., Beloumou G; Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon., Sosso S; Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon., Moudourou S; Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon., Teto G; Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon., Dambaya B; Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon., Djupsa S; Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon., Tetang Ndiang S; National Social Welfare Hospital (NSWFH), Yaoundé, Cameroon., Ateba FN; Mother-Child Centre of the Chantal BIYA's foundation (MCC-CBF), Yaoundé, Cameroon., Billong SC; Faculty of Medicine and Biomedical Sciences (FMSB), University of Yaoundé I, Yaoundé, Cameroon.; National HIV Drug Resistance Working Group (HIVDRWG), Ministry of Public Health, Yaoundé, Cameroon.; Central Technical Group, National AIDS Control Committee (NACC), Yaoundé, Cameroon., Kamta C; Mfou District Hospital (MDH), Mfou, Cameroon., Bala L; Mbalmayo District Hospital (MDH), Mbalmayo, Cameroon., Lambo V; Nkomo Medical Center (NMC), Nkomo, Cameroon., Tala V; Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon.; Faculty of Medicine and Biomedical Sciences (FMSB), University of Yaoundé I, Yaoundé, Cameroon., Chenwi Ambe C; Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon.; Faculty of Medicine and Biomedical Sciences (FMSB), University of Yaoundé I, Yaoundé, Cameroon., Mpouel ML; Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon.; Faculty of Medicine and Biomedical Sciences (FMSB), University of Yaoundé I, Yaoundé, Cameroon., Cappelli G; National Research Council, Rome, Italy., Cham F; World Health Organisation Africa Multilingual Expert Laboratory Trained (MELT) group, Brazzaville, Congo.; Global Funds for the fight against AIDS, Malaria and Tuberculosis, Geneva, Switzerland., Ndip R; Faculty of Science (FS), University of Buea, Buea, Cameroon., Mbuagbaw L; Faculty of Health Sciences (FHS), University of Buea, Buea, Cameroon., Koki Ndombo P; Faculty of Medicine and Biomedical Sciences (FMSB), University of Yaoundé I, Yaoundé, Cameroon.; Mother-Child Centre of the Chantal BIYA's foundation (MCC-CBF), Yaoundé, Cameroon., Ceccherini-Silberstein F; University of Rome Tor Vergata (UTV), Rome, Italy., Colizzi V; Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon.; University of Rome Tor Vergata (UTV), Rome, Italy., Perno CF; Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon.; World Health Organisation Africa Multilingual Expert Laboratory Trained (MELT) group, Brazzaville, Congo.; University of Milan (UM), Milan, Italy., Ndjolo A; Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon.; Faculty of Medicine and Biomedical Sciences (FMSB), University of Yaoundé I, Yaoundé, Cameroon.
Jazyk: angličtina
Zdroj: HIV medicine [HIV Med] 2021 Aug; Vol. 22 (7), pp. 567-580. Date of Electronic Publication: 2021 Mar 31.
DOI: 10.1111/hiv.13095
Abstrakt: 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 (CD 4  < 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.
(© 2021 British HIV Association.)
Databáze: MEDLINE
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