Authors:
Joseph Fokam, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Ezechiel Ngoufack Jagni Semengue, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Evariste Molimbou, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Naomi-Karell Etame, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Maria Mercedes Santoro, University of Rome Tor Vergata, Rome-Italy
Désiré Takou, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Leonella Mossiang, Hopital Central de Yaoundé
Alain Patrice Meledie, Hopital Général de Douala
Collins Chenwi Ambe, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Bouba Yagai, Comité national de lutte contre le VIH/SIDA, Yaoundé, Cameroun
Alex Durand Nka, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Beatrice Dambaya, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Georges Teto, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Aude Christelle Ka'e, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Grace Angong Beloumou, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Sandrine Claire Djupsa, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Nadine Fainguem, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Aissatou Abba, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Aurelie Minelle Ngueko Kengni, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Michel Carlos Tommo Tchouaket, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Nounouce Pamen Bouba, Directorate for Disease, Epidemic and Pandemic Control, Yaoundé-Cameroon
Serges Clotaire Billong, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé-Cameroun
Rina Djubgang, 14. Directorate of Pharmacy, Drug and Laboratory, Ministry of Public Health, Yaoundé-Cameroon
Edith Saounde Temgoua, Comité national de lutte contre le VIH/SIDA, Yaoundé, Cameroun
Samuel Martin Sosso, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Charles Kouanfack, Hopital Central de Yaoundé
Anne-Cecile Zoung-Kanyi Bissek, Division of Operational Health Research, Ministry of Public Health, Yaoundé-Cameroon
Emmanuel Eben-Moussi, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Vittorio Colizzi, Evangelical University of Cameroon, Bandjoun-Cameroon
Carlo-Federico Perno, Bambino Gesu Pediatric Hospital, Rome-Italy
Francesca Ceccherini Silberstein, University of Rome Tor Vergata, Rome-Italy
Alexis Ndjolo, Chantal BIYA International Reference Centre for research on HIV/AIDS management and care, Yaoundé, Cameroon
Background: In order to ensure long-term efficacy of dolutegravir (DTG), we evaluated the genotypic profile in viral reservoirs among patients on third line antiretroviral therapy (ART) in Cameroon, according to prior exposure to raltegravir (RAL).
Methods: A facility-based study was conducted from May throughout December 2021, among patients on third line from HIV treatment centres in Yaoundé and Douala. Viral load was measured, and genotyping was performed on plasma-RNA and pro-viral DNA. HIV-1 drug resistance mutations were interpreted using HIVdb.v9.1 and phylogeny was performed using MEGA.v7, with p<0.05 considered significant.
Results: Of the 12,093 patients on ART, 53 fully met our inclusion criteria. Median [IQR] age was 51 [40-55] years and the M/F sex-ratio was 4/5. Median duration on integrase strand-transfer inhibitors (INSTI)-containing regimens was 18 [12-32] months; 15.09% (8/53) were exposed to RAL and the most administered third line was TDF+3TC+DTG+DRV/r (33.96%, 18/53). Only 5.66% (3/53) had unsuppressed viremia (>1000 copies/ml). Resistance testing in pro-viral DNA was successful for 18/22 participants and revealed 1/18 patient (5.56%, in the RAL-arm) with archived mutations at major resistance positions (G140R, G163R). Five subtypes were identified, CRF02_AG (12/18), CRF22_01AE (3/18), A1 (1/18), G (1/18) and F2 (1/18).
Conclusions: In Cameroon, third line experienced patients have a good virological response with low level of archived mutations in the integrase. This finding underscores the use of DTG containing ART for heavily treated patients in similar programmatic settings. However, patients with prior exposure to RAL should be closely monitored following a stratified or personalized approach to mitigate risks of INSTI resistance, alongside pharmacovigilance.
