1. Genotypic resistance testing improves antiretroviral treatment outcomes in a cohort of adolescents in Cameroon: Implications in the dolutegravir-era.
- Author
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LE ROI TOGNA PABO, WILLY, NJUME, DEBIMEH, NDIP, ROLAND NDIP, TAKOU, DÉSIRÉ, SANTORO, MARIA-MERCEDES, CHENWI, COLLINS, BELOUMOU, GRACE, SEMENGUE, EZECHIEL NGOUFACK JAGNI, NKA, ALEX DURAND, KA'E, AUDE CHRISTELLE, TETO, GEORGES, DAMBAYA, BEATRICE, DJUPSA, SANDRINE, NYASA, RAYMOND BABILA, ANGUECHIA, DAVY HYACINTHE GOUISSI, KAMTA, CEDRIC, BALA, LIONEL, LAMBO, VIRGINIE, SOSSO, SAMUEL MARTIN, and COLIZZI, VITTORIO
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ANTIRETROVIRAL agents ,BK virus ,TREATMENT effectiveness ,GENOTYPES ,TEENAGERS ,PEDIATRIC therapy - Abstract
Acquired drug resistance (ADR) is common among adolescents living with perinatal HIV (APHI) in sub-Saharan Africa (SSA). Personalized management has the potential to improve pediatric antiretroviral therapy (ART), even in the presence of long-term treatment and HIV-1 subtype diversity. We sought to evaluate the effect of HIV-1 mutational profiling on immuno-virological response and ADR among APHI. A cohort-study was conducted from 2018-2020 among 311 APHI receiving ART in Cameroon. Clinical, immunological and virological responses were measured at enrolment (T1), 6-months (T2) and 12-months (T3). Immunological failure (IF: CD4 <250 cells/mm3), VF (viremia =1,000 copies/ml), and ADR were analyzed, with P<0.05 considered significant. Mean age was 15(±3) years; male-female ratio was 1:1; median [IQR] ART-duration was 36[21-81] months. At T1, T2, and T3 respectively, adherence-level was 66.4, 58.3 and 66.5%; 14 viral clades were found, driven by CRF02_AG (58.6%); ADR-mutations favored increased switch to second-line ART (16.1, 31.2, and 41.9%, P<0.0001). From T1-T3 respectively, there were declining rates of IF (25.5, 18.9, and 9.83%, P<0.0001), VF (39.7, 39.9, and 28.2%, P=0.007), and HIVDR (96.4, 91.7, and 85.0%, P=0.099). Predictors of ADR were being on first-line ART (P=0.045), high viremia at enrolment (AOR=12.56, P=0.059), and IF (AOR=5.86, P=0.010). Of note, optimized ART guided by mutational profile (AOR=0.05, P=0.002) was protective. Moreover, full Tenofovir+Lamivudine+ Dolutegravir efficacy was predicted in 77 and 62% of APHI respectively after first- and second-line failure. Among APHI in this SSA setting, viral mutational profiling prompts the use of optimized Dolutegravir-based ART regimens, leading to improved immuno-virological response and declining ADR burdens. Thus, implementing personalized HIV medicine in this vulnerable population would substantially improve ART response and the achievement of the 95-95-95 goals in these underserved populations. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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