Background: Monitoring of HIV-infected patients with long-term treatment remains challenging in low- and middle-income countries (LMICs) due to risks of multi-class HIV drug resistance (HIVDR). Following a personalized strategy, we sought to evaluate the treatment response among patients with multi-class HIVDR following genotypic resistance guided switch in Cameroon.
Methodology: A cohort-study was conducted in the South-west region of Cameroon among patients failing non-nucleoside reverse transcriptase inhibitors (NNRTI)-based and protease inhibitor (PI)-based antiretroviral treatment (ART) from 2018-2023. Following HIV-1 genotypic resistance testing (GRT), patients were switched to most-effective therapies and viral load (VL) was monitored after 3-, 6-, 12-, 24-, and 36-months. Data analysis used Epi Info v.7.2, with p<0.05 considered statistically significant.
Results: From the 336 patients failing ART in the region, 170 (50.6%) presented with GRT results; from these, 72 were further lost-to-follow-up, 12 died and 5 defaulters, giving 81 study-inclusions (57.5% females; 47/81). Before GRT, about 64.2% (52/81) were failing PI-based and the median CD4 and VL were 232.5 [161.25–401.25] cells/µL and 54,480 [13,932.5–220,153] copies/mL respectively. The most prevailing mutations at inclusion were M184I/V (26.1%), K103N/S (20.7%) and M46I/L (32.8%) for NRTI, NNRTI and PI respectively; with CRF02_AG as the prevailing viral clade (71.4%). Following GRT, 92.6% (75/81) of the participants respected the recommended regimen. Viral suppression (VL<1000copies/ml) post-GRT was 80% at 3-months, 84.8% at 6 months, 81.4% at 12 months, 93.7% at 24 months and 86.7% at 36 months. Neither gender, nor age, baseline regimens, CD4 and VL, GRT profiles, were found to be associated with participants’ therapeutic outcome (all p-values >0.05).
Conclusion: Our findings show high rates of VL suppression following GRT-guided switch in individuals harboring HIVDR mutations. This underscores the significance of personalizing ART management for difficult-to-treat people to achieve HIV control by 2030 in LMICs.