Joseph FOKAM1, Desire TAKOU1, Maria Mercedes SANTORO2, Armanda NANGMO3*, Carlson WANDUM3 , Anne-Esther NJOM NLEND4, Francis NDONGO ATEBA5, Paul KOKI NDOMBO5, Dora MBANYA3, Vittorio COLLIZI2, Carlo- Frederico PERNO2, Alexis NDJOLO1
1Chantal BIYA International Reference Center for research on HIV/AIDS; 2University of Rome Tor Vergata, Rome ; 3University of Bamenda ; 4National Social Welfare Hospital ; 5Mother-Child Center of the Chantal BIYA'S foundation
CaHReF 2018, Yaoundé Congres hall, 08 – 11 January 2019 , OSEP054
Background: Transitioning from pediatric- to adult-antiretroviral therapy (ART) requires a successful ART-response among adolescents, particularly in urban settings with extended use of ART. This implies monitoring ART response and HIV drug resistance (HIVDR) patterns in order to select optimal ART-regimens for adolescents living in resource-limited urban settings like Yaoundé, in Cameroon.
Objectif: To evaluate clinical, immunological and virological responses, HIV-1 drug resistance (HIVDR) and genetic variability among ART-experienced adolescents in urban settings of the Centre region.
Methodology: As part of the EDCTP-READY study, a cross-sectional study was conducted from February-July 2018 among HIV vertically infected adolescents (10-19 years old) receiving ART in two reference pediatric centers of Yaoundé: The Chantal BIYA Foundation's Mother-Child Centre (MCC) and the National Social Welfare Hospital (NSWH). WHO-clinical staging (clinical failure defined as WHO-stage 3/4), CD4-counts (immunodeficiency defined as CD4 <500 cells/mm3) and plasma viral load (virological failure [VF] defined as? 1000 RNA copies/ml) were determined. In case of VF, HIVDR profiling and subtyping were performed by genotyping and molecular phylogeny respectively. Statistical analyses were performed, with p <0.05 was considered statistically significant.
Results : Of the 212 eligible adolescents, 55.7% were female; median-age was 15[IQR:13-17]years MCC versus 14.5[IQR:13-17]years NSWH; ART-duration varied significantly (6[IQR:3-10]years MCC versus 9[IQR:2-7]years NSWH, p=0.0018); and 79% was on non-nucleoside reverse transcriptase Inhibitors (NNRTI)-based regimens. Clinical failure was low (4.3% [9/210] MCC versus 3,2% [3/92]) in NSWH), p=0.29; immunodeficiency was 52% (61/118)MCC versus 29% (26/90)NSWH, p=0.001. Overall VF was 38.17%, with 49.16%(59/120) MCC versus 27.17%(25/92) NSWH, p=0.126. Among those experiencing VF (18754: [1729-128565] RNA copies/ml), 15 sequences-generated showed 93.3% overall HIVDR, with 93.3% NNRTI-resistance, 73.3% NRTI-resistance and 14% PI/r-resistance. All were HIV-1 group M, with 73.3%CRF02_AG and 26.6%others (A1, F1, CRF13.cpx).
Conclusion/Recommandation: In these urban settings of Cameroon, HIV-vertically infected adolescents appear clinically asymptomatic regardless of difference in ART-duration. Despite disparities in immune responses, the high rate of VF in both sites warrants a regular viral load monitoring for a timely detection of ART and appropriate therapeutic switch guided by genotyping for those on PI/r-based regimens. These actions would improve viral suppression, reduce HIVDR-emergence, and ensure greater transition of adolescents to adult care in urban settings.
Key Words: Treatment response, HIV drug resistance, Adolescents