Abstract
BackgroundPopulation-based studies to estimate viral load (VL) suppression and rate of acquired HIV drug resistance (ADR) are essential in sub-Saharan Africa. We conducted the first nationally representative study estimating VL suppression and ADR in Cameroon. MethodsEligible participants were patients on antiretroviral therapy (ART) for 12 to 24 months (ART 12–24) or 48 to 60 months (ART 48–60). ART 12–24 participants were recruited from 24 randomly selected clinics in both urban and rural regions. ART 48–60 participants were recruited from 7 urban clinics. Recruitment occurred from February to August 2015. Dried blood spots (DBSs) and plasma specimens were collected and tested for HIV-1 RNA level and presence of drug resistance mutations (DRM) when VL ≥1000 copies/ml. ResultsOverall, 1064 ART 12–24 and 388 ART 48–60 participants were recruited. Viral suppression in the ART 12–24 group was 72.1% (95% CI: 66.3–77.2) overall, 75.0% (65.2–82.7) in urban sites, and 67.7% (58.3–75.8) in rural sites. In the ART 48–60 group, viral suppression was 67.7% (55.8–77.7). Overall, HIV drug resistance (HIVDR) was 17.7% (15.1–20.6) and 28.3% (17.4–42.5) in the ART 12–24 and ART 48–60 groups, respectively. However, among patients with VL ≥1000 copies/ml, HIVDR was identified in 63.3% (52.0–73.3) of ART 12–24 patients, and in 87.7% (67.4–96.1) of ART 48–60 patients. ConclusionsResults of this first nationwide study indicate alarming levels of virological failure and ADR in Cameroon. Better ART management is urgently needed and should focus on improving ART adherence, availability of VL monitoring, and more timely switches to second-line ART.
Highlights
Thirty years in the global fight against the acquired immune deficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV) have provided critical lessons and important insights concerning the origin, epidemiology and evolution of this infection.⁎ Corresponding author at: CREMER, Virology Laboratory IMPM/IRD, Rue Elig-Essono, P.O
While historically the focus has been on rapid scale-up of antiretroviral therapy (ART), and approximately 18 million individuals are receiving ART globally, is increasingly important to assess whether those receiving ART achieve viral load (VL) suppression and the emergence of HIV drug resistance (HIVDR) among individuals failing ART
The 12–24 months assessment aims at evaluating virological failure during the first years of ART initiation, and the 48–60 months assessment evaluates the outcome later after ART initiation
Summary
Thirty years in the global fight against the acquired immune deficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV) have provided critical lessons and important insights concerning the origin, epidemiology and evolution of this infection.⁎ Corresponding author at: CREMER, Virology Laboratory IMPM/IRD, Rue Elig-Essono, P.O. The Joint United Nations Programme on HIV/AIDS (UNAIDS) has established the goal of ending the AIDS epidemic by 2030 [1] This UNAIDS strategy includes several important sub-objectives, one of which is to reach “90% of virological suppression in all people receiving antiretroviral therapy” by 2020. Population-based studies to estimate viral load (VL) suppression and rate of acquired HIV drug resistance (ADR) are essential in sub-Saharan Africa. Viral suppression in the ART 12–24 group was 72.1% (95% CI: 66.3–77.2) overall, 75.0% (65.2–82.7) in urban sites, and 67.7% (58.3–75.8) in rural sites. HIV drug resistance (HIVDR) was 17.7% (15.1–20.6) and 28.3% (17.4–42.5) in the ART 12–24 and ART 48–60 groups, respectively. Better ART management is urgently needed and should focus on improving ART adherence, availability of VL monitoring, and more timely switches to second-line ART
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