Virological failure and antiretroviral resistance among HIV-infected children after five years follow-up in the ANRS 12225-PEDIACAM cohort in Cameroon.

Paul Alain Tagnouokam-Ngoupo,Albert Faye,Jules Brice Tchatchueng Mbougua,Angeladine Kenne,Mathurin Cyrille Tejiokem,Ida Calixte Penda,Francis Yuya Septoh,Sorel Jakpou,Suzie Tetang Ndiang,Jeannine Eboumbou Ngallè,Francis Ateba Ndongo,Josiane Warszawski,The Anrs-Pediacam Study Group

doi:10.1371/journal.pone.0248642

Abstract

ObjectiveIn the present study, we aimed to evaluate the virological failure (VF) and drug resistance among treated HIV-infected children after five years follow-up in the ANRS-Pediacam cohort in Cameroon.MethodsFrom November 2007 to October 2011, HIV-infected children born to HIV-infected mothers were included in the ANRS-PEDIACAM study and followed-up for more than 5 years. Plasma viral load (VL) was measured at each visit (every three months until month 24 and every 6 months thereafter). VF was the main outcome and HIV drug resistance test was performed using the ANRS procedures and algorithm.ResultsData from 155 children were analyzed. The median age at combination antiretroviral therapy (cART) initiation was 4.2 months (interquartile range (IQR): 3.2–5.8), with 103 (66.5%) children taking LPV/r-containing regimen and 51 (32.9%) children taking NVP. After five years follow-up, 63 (40.6%; CI: 32.9–48.8) children experienced VF. The median duration between cART initiation and VF was 22.1 months (IQR: 11.9–37.1) with a median VL of 4.8 log10 (IQR: 4.0–5.5). Among the 57 children with HIV drug resistance results, 40 (70.2%) had at least one drug resistance mutation. The highest resistance rates (30.4–66.1%) were obtained with Lamivudine; Efavirenz; Nevirapine and Rilpivirine.ConclusionsThese results show high resistance to NNRTI and emphasize the need of VL and resistance tests for optimal follow-up of HIV-infected people especially children.

Highlights

In 2018, UNAIDS estimated that 37.9 million people were living with HIV worldwide
The highest resistance rates (30.4–66.1%) were obtained with Lamivudine; Efavirenz; Nevirapine and Rilpivirine. These results show high resistance to NNRTI and emphasize the need of viral load (VL) and resistance tests for optimal follow-up of HIV-infected people especially children
About 54% of children living with HIV were receiving combination antiretroviral therapy in 2018 globally and more efforts are needed to scale up treatment in this vulnerable population [1, 3]

Summary

Introduction

1.7 million were children under 15 years with 160,000 newly infected mainly by vertical transmission [1]. An estimated 1.6 million new HIV infections among children have been averted, since 1995, with the use of antiretroviral (ARV) medicines in women living with HIV during pregnancy and breastfeeding [2]. About 54% of children living with HIV were receiving combination antiretroviral therapy (cART) in 2018 globally and more efforts are needed to scale up treatment in this vulnerable population [1, 3]. It is well known that early cART in children helps in improving immune reconstitution, decreasing AIDS-related mortality and millions of lives have been saved since the adoption of this treatment strategy [4, 5]. In Cameroon, many efforts have been developed in order to reduce the HIV burden in children through the prevention of mother-to-child transmission (PMTCT) and one main strategy was the adoption and implementation of the option B+ in 2012 [6]

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Results

Conclusion