Viral suppression in adults, adolescents and children receiving antiretroviral therapy in Cameroon: adolescents at high risk of virological failure in the era of "test and treat".

BACKGROUND: After the launching of the « Test & Treat ¼ strategy and the wider accessibility to viral load (VL), evaluating virological success (VS) would help in meeting the UNAIDS targets by 2020 in Cameroon. SETTING AND METHODS: Cross-sectional study conducted in the Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon; data generated between October 2016 and August 2017 amongst adults, adolescents and children at 12, 24, 36 and ≥ 48 months on ART. VS was defined as < 1000 copies/mL of blood plasma and controlled viremia as VL < 50 copies/mL. Data were analysed by SPSS; p < 0.05 considered as significant. RESULTS: 1946 patients (70% female) were enrolled (1800 adults, 105 adolescents, 41 children); 1841 were on NNRTI-based and 105 on PI-based therapy; with 346 patients at M12, 270 at M24, 205 at M36 and 1125 at ≥ M48. The median (IQR) duration on was 48 months (24-48). Overall, VS was 79.4% (95% CI 77.6-81.2) and 67.1% (95% CI 64.9-69.1) had controlled viral replication. On NNRTI-based, VS was 79.9% vs. 71.4% on PIs-based, p = 0.003. By ART duration, VS was 84.1% (M12), 85.9% (M24), 75.1% (M36) and 77.2% (≥ M48), p = 0.001. By age, VS was 75.6% (children), 53.3% (adolescents) and 81.1% (adults), p < 0.001. CONCLUSIONS: In this sub-population of patients receiving ART in Cameroon, about 80% might be experiencing VS, with declining performance at adolescence, with NNRTI-based regimens, and as from 36 months on ART. Thus, improving VS may require an adapted adherence support mechanism, especially for adolescents with long-term treatment in resource-limited settings.

Evaluation of Virologic Methods for Early Detection of HIV-1 in a Resource-limited Setting: Performance and Cost Analysis

Introduction : Rapid testing and detection of acute HIV infection are two important arms in the prevention of HIV infection. Virologic testing for HIV remains the mainstay for early diagnosis of the infection. Nucleic acid-based testing for HIV however; requires expensive laboratory infrastructure and well-trained personnel; thereby making it not easily accessible in Low- Middle- Income Countries (LMIC). HIV DNA polymerase chain reaction is currently used by few laboratories in many LMIC to detect HIV in children born of HIV-positive mothers before 18 months. Challenges relating to timely result notification can be reduced if the Early Infant Diagnosis (EID) Programme is decentralized and with easy access to laboratory facilities using other tests with high performance characteristics. Methods: We evaluated the performance of five assays to identify HIV antibodies; p24 antigen; proviral DNA or viral RNA in 109 infants born to HIV-positive mothers in Yaounde; Cameroon. Results: The test performance (using plasma) of the HIV p24 antigen ELISA by Perkin Elmer; Roche Amplicor HIV-1 DNA PCR and the Abbott Realtime HIV-1 assay was 100 identifying 12 positive cases. A positive and significant correlation between the HIV-1 RNA viral load and HIV p24 antigen level was found (p0.05). Conclusion: Therefore; HIV p24 antigen detection by ELISA can be used for early diagnosis of HIV and thus recommended for a decentralized EID Programme in LMIC