Context:
Transition to Dolutegravir (DTG)-based antiretroviral therapy (ART) may improve virological response (VR) in sub-Saharan Africa. Because VR may vary by age, understanding ART response across age-range may inform interventions on ART program. Our objective was to compare VR between children, adolescents and adults in the Cameroonian context.
Methods
A comparative study was conducted from January 2021 to May 2022 amongst ART-experienced patients received at the Chantal BIYA International Reference Centre for HIV/AIDS prevention and management in Yaoundé-Cameroon for plasma viral load (PVL) monitoring. PVL was measured on Abbott m2000RT-PCR as per manufacturer’s instructions. VR was defined as viral suppression (VL<1000 copies/mL) and viral undetectability (VL<50 copies/mL). Data were analyzed by SPSS v.20.0, with p<0.05 considered as significant.
Results
A total of 9034 patients, 72.2% female, were enrolled (8565 adults, 227 adolescents, 222 children); 1618 were on NNRTI-based, 299 on PI-based and 7117 on DTG based ART (92 children, 198 adolescents, 6824 adults). Median (IQR) duration on ART was 36 (27-39) months. Overall, VS was 89.9% (95% CI: 89.2-90.5) and 75.8% (95% CI 74.8-76.7) had achieved viral undetectability. By ART-regimen, VS on NNRTI-based, PI/r-based, and DTG-based therapy was respectively 86.5%, 60.2% and 91.9%, p<0.0001. By ART duration, VS was respectively 90.4% (M12), 87.8% (M24), 89.1% (M36) and 90.0% (≥ M48), p<0.0001. By sex, VS was 91.0% for female and 87.1% for male, p<0.0001. Most importantly, VS by age was significantly different, ranging from 65.2% in children, 74.4% in adolescents and 90.9% om adults, p<0.0001.
Conclusion
In the current ART program, nine out of ten Cameroonian patients achieve VS, with a superior efficacy of DTG-based ART (mainly adults). Nonetheless, male and pediatric populations have poorer rates of VS, especially for children below 10 years. Thus, scaling-up pediatric DTG-based ART, especially in children, would improve ART performance in similar African settings.