Evaluation of Viral Suppression in Paediatric Populations: Implications for the Transition to Dolutegravir-Based Regimens in Cameroon: The CIPHER-ADOLA Study.

Mortality in children accounts for 15% of all AIDS-related deaths globally, with a higher burden among Cameroonian children (25%), likely driven by poor virological response. We sought to evaluate viral suppression (VS) and its determinants in a nationally representative paediatric and young adult population receiving antiretroviral therapy (ART). A cross-sectional and multicentric study was conducted among Cameroonian children (<10 years), adolescents (10-19 years) and young adults (20-24 years). Data were collected from the databases of nine reference laboratories from December 2023 to March 2024. A conditional backward stepwise regression model was built to assess the predictors of VS, defined as a viral load (VL) <1000 HIV-RNA copies/mL. Overall, 7558 individuals (females: 73.2%) were analysed. Regarding the ART regimen, 17% of children, 80% of adolescents and 83% of young adults transitioned to dolutegravir (DTG)-based regimens. Overall VS was 82.3%, with 67.3% (<10 years), 80.5% (10-19 years) and 86.5% (20-24 years), and p < 0.001. VS was 85.1% on a DTG-based regimen versus 80.0% on efavirenz/nevirapine and 65.6% on lopinavir/ritonavir or atazanavir/ritonavir. VS was higher in females versus males (85.8% versus 78.2%, p < 0.001). The VS rate remained stable around 85% at 12 and 24 months but dropped to about 80% at 36 months after ART initiation, p < 0.009. Independent predictors of non-VS were younger age, longer ART duration (>36 months), backbone drug (non-TDF/3TC) and anchor drug (non-DTG based). In this Cameroonian paediatric population with varying levels of transition to DTG, overall VS remains below the 95% targets. Predictors of non-VS are younger age, non-TDF/3TC- and non-DTG-based regimens. Thus, efforts toward eliminating paediatric AIDS should prioritise the transition to a DTG-based regimen in this new ART era.

The declining trend of HIV-Infection among pregnant women in Cameroon infers an epidemic decline in the general population.

BACKGROUND: HIV remains a generalised epidemic in Cameroon, with regular sentinel surveillance surveys (SSS) conducted among pregnant women to monitor the epidemiological dynamics, and for strategic policy making. Our main objective was to actualise data on HIV epidemiology, and compare the trends overtime among pregnant women versus data from the general population in Cameroon. METHODS: Sentinel surveillance was conducted in 2016 among pregnant women in the 10 regions (60 sites) of Cameroon, targeting 7,000 first antenatal care (ANC-1) attendees (4,000 in urban; 3,000 in rural). HIV testing was done following the serial national algorithm at the National Public Health Laboratory. Results of 2016 were compared with 2009 and 2012 dataset, alongside reports from the general population; with p < 0.05 considered statistical significant. FINDINGS: A total of 6,859 ANC-1 (97.99% sampling) were enrolled in 2016, with 99.19% (6,513/6,566) acceptability for HIV testing; similar to performances in 2009 and 2012 (>99%). National prevalence of HIV was 5.70% (389/6,819), similar between urban (5.58%) and rural (5.87%) settings. HIV prevalence among pregnant women declined significantly from 2009 (7.6%), 2012 (7.8%) to 2016 (5.7%), p < 0.0001; with a similar declining trend in the general population: from 2004 (5.5%), 2011 (4.3%) to 2017 (3.4%), p < 0.0001. Difference between SSS and the population-based survey was non-significant (r = 0.6; p = 0.285). Following geographical settings, HIV prevalence was higher in urban vs. rural settings from 2009-2012 (p < 0.0001), followed by similar rates in 2016. Early-age infection (15-24 years) decreased from 6.7% in 2009 to 3.4% in 2016, with remarkable declines in new infections within the age ranges 15-19 years (5.1%-1.57%) and 20-24 years (7.8%-4.39%). INTERPRETATION: With high acceptability in HIV testing, the prevalence of HIV-infection through SSS indicates a declining but generalised epidemic among pregnant women in Cameroon. Of note, as the declining prevalence among pregnant women also reflects an epidemic reduction in the general population, SSS represents an efficient strategy to understand the dynamics of HIV epidemics in the general Cameroonian population, pending validation by periodic population surveys.

Evaluation of the effect of HIV virus on the digestive flora of infected versus non infected infants.

INTRODUCTION: HIV infection is characterized by changes in the composition and functions of gut microbiota. We carried out a study aiming at comparing the compositional changes of the digestive flora of HIV infected infants versus that of non infected infants in Cameroon. METHODS: A case-control study was carried out during which stool sample was collected from each participant after obtaining the proxy consent. Stools were cultured using aerobic, strict anaerobic, 10% CO2 and micro-aerophilic conditions and specific culture media and bacteria were identified biochemically. Fisher's exact test was used for data analyses. RESULTS: From the 80 infants enrolled for the study, 33 (41.3%) were HIV positive. A statistically significant difference was observed between the number of infected versus non infected infants harboring the following bacteria: Clostridium spp. (P=0.009); Enterococcus spp. (p<0.001); Klebsiella (p<0.001); Shigella (<0.001); Staphylococcus aureus (p=0.006) and Streptococcus spp. (P=0.015). Among infected infants, WHO-stage 3 and 4 infants harbored more opportunistic bacteria than stage 1 and stage 2 and Bacteriodes spp. population was depleted as the disease progresses, although not significantly. There was an imbalance in bacteria flora in HIV infected infants harboring qualitatively more bacteria including more opportunistic and pathogenic bacteria than in HIV non-infected infants. CONCLUSION: HIV infected infants presented a qualitatively different flora from HIV non infected infants. They habored more pathogenic bacteria Than non infected infants. Systematic stool culture could benefit for follow-up of HIV infected infants to reduce the risk of gastrointestinal disorders and thus the risk of high morbidity or high mortability.

Factors associated with risk of HIV-infection among pregnant women in Cameroon: Evidence from the 2016 national sentinel surveillance survey of HIV and syphilis.

BACKGROUND: Human Immunodeficiency Virus infection (HIV) remains a public health concern in Cameroon that requires regular surveillance for informed policy-making to guide programmatic interventions. Using data from the 2016 HIV national sentinel survey in Cameroon, we ascertained HIV prevalence and factors associated with risk of infection among pregnant women. METHODS: A cross-sectional study was conducted throughout 2016 in the 10 regions of Cameroon, targeting 7000 first antenatal care (ANC-1) attendees (4000 from urban and 3000 from rural areas) in 60 sentinel health facilities. HIV serological test was performed using the national serial algorithm at the National Reference Laboratory (NRL). Prevalence was determined, and multivariate logistic regression was used to assess determinants of HIV infection, with p-value<0.05 considered statistically significant. RESULTS: Of the 7000 targeted participants, a total of 6859 first ANC-1 attendees were enrolled (98.0% sampling coverage). Median age was 26 [IQR: 21-30] years and 47,40% had a secondary school level of education. The national prevalence of HIV was 5.70% (95% CI: 4.93-6.40) and range from 9.7% in East region to 2.6% in North region. The prevalence was 5.58% (95% CI: 95%: 4.88-6.35) in urban and 5.87% (95% CI: 5.04-6.78) in rural settings. Factors that were associated with HIV infection included marital status, women who were married or living with their partner are less likely to be infected than singles women (aOR = 0.60; 95% CI: 0.46-0.78), multiparity [aOR = 1.5(95%CI:1.0-2.2)] and been living in the Centre, East, North-west and South-west regions. HIV infection was also significantly associated with age, with the risk of being infected increasing with age. CONCLUSION: Pregnant women in Cameroon are still disproportionately infected with HIV compared with the general population (prevalence 4.3%). Preventive actions to curb the epidemic amongst pregnant women should prioritize interventions targeting single pregnant women, who are older, and residing particularly in the Centre, East, North West and South West regions of the country.

Maternal age, infant age, feeding options, single/multiple pregnancy, type of twin sets and mother-to-child transmission of HIV.

BACKGROUND: Some risk factors for mother-to-child transmission (MTCT) of HIV have been identified. To further reduce MTCT, other risk factors were evaluated. MATERIALS AND METHODS: A retrospective study on early infant diagnosis was conducted. Two-sided chi-square test was used to assess associations with infant HIV status. RESULTS: A total of 15 233 HIV-infected mothers and 15 404 infants were recruited. MTCT rate was 9.34%. Only 3.8% of infants born to mothers on antiretroviral treatment were infected. Under nevirapine, 4.1% of infants were infected. MTCT increased with infant' age at testing. Younger mothers tend to transmit more HIV (P = 0.003). More children were infected in single pregnancies compared with multiple pregnancies, P < 0.001. There were more infections in male-female twins' sets (P = 0.037). CONCLUSIONS: Maternal age, type of pregnancy and twins' sets are new MTCT risk factors. Strategies to further decrease transmission through family planning, pre/post natal consultations and clinical practices are needed.