Background: HIV affects 2% of Cameroonian adolescents. Despite Antiretroviral therapy(ART) use, poor adherence and HIV drug resistance(HIVDR) emergence remain setbacks for treatment response in adolescents living with perinatal HIV infection(ALPHI)
Objective: Assess effect of adherence on virological response to ART and acquired HIVDR in ALPHI in two paediatric hospitals.
Methodology: A prospective cohort study was conducted amongst ALPHI aged 10-19. 214 participants were enrolled at baseline and followed up at 2 periods. Self–reported adherence(% missed doses in last 30 days) and plasma viral load(PVL) were observed at each phase. If virological failure/VF(PVL>1000copies/ml), genotypic resistance testing(GRT) was performed, interpreted using the Stanford Algorithm(v.8.8). Rates of VF, once-daily ART dosing and HIVDR were compared for adherent and non adherent participants. Statistical analysis was done on EpiInfov.7.2.4.0.
Results: Of 214 participants, 196 and 176 were followed at second and third phases. Median age was 15±3years; with 55.4% in the older age group(15-19years). Self-reported adherence was 78.5%, 66.8% and 67.1% respectively. At baseline and 2nd phase, poor adherence was associated with older age; (OR=3, p=0.004; RR=1.2, p= 0.01) and once-daily regimen use(OR=3, p=0.01; RR=1.3, p=0.006). VF decreased from 41.6% to 26.1%(p=0.002), indicating increased viral suppression(VS) 58.7%-73.8. VF was two-fold higher with poor adherence(RR=2, p=0.0002; RR=2, p=0.004) at 2nd and 3rd phases. GRT performance increased from 75%-97.8%, with poor prescription practice from 36.2%-48.3%(p=0.15); underscoring retention on poorly-active regimens, limiting VS and prompting DRM accumulation. DRM rates were 90.9%, 79.9% and 71.1%.
Conclusion: ALPHI in Cameroonian urban settings have dwindling adherence levels, worsened by older age and single-dose regimens. VF decreased due to improved adherence counselling and GRT performance. Poor adherence increased VF two-fold and HIVDR remained high in both adherent and non-adherent adolescents on sub-optimal therapy. Hence, capacity-building on GRT result use and reinforced adherence, particularly in older adolescents and those on single-dose regimens, is paramount for VS.