Fokam Joseph, Bouba Yagai, Ajeh Rogers Awoh, Guebiapsi Dominik Tameza, Essamba Suzane, Zeh Meka Albert Franck, Lifanda Ebiama, Ada Rose Armelle, Yakouba Liman, Mbengono Nancy Barbara, Djomo Audrey Raissa Dzaddi, Tetang Suzie Ndiang, Sosso Samuel Martin, Babodo Jocelyne Carmen, Ambomo Olivia Francette Ndomo, Temgoua Edith Michele, Medouane Caroline, Atsinkou Sabine Ndejo, Mvogo Justin Leonel, Onana Roger Martin, Anoubissi Jean de Dieu, Ketchaji Alice, Nka Alex Durand, Gouissi Davy-Hyacinthe Anguechia, Ka'e Aude Christelle, Fainguem Nadine Nguendjoung, Kamgaing Rachel Simo, Takou Désiré, Tchouaket Michel Carlos Tommo, Semengue Ezechiel Ngoufack Jagni, Atsama Marie Amougou, Nwobegahay Julius, Vuchas Comfort, Nsimen Anna Nya, Bille Bertrand Eyoum, Gatchuessi Sandra Kenmegne, Ateba Francis Ndongo, Kesseng Daniel, Billong Serge Clotaire, Armenia Daniele, Santoro Maria Mercedes, Ceccherini-Silberstein Francesca, Koki Paul Ndombo, Hamsatou Hadja Cherif, Colizzi Vittorio, Ndjolo Alexis, Perno Carlo-Federico, Zoung-Kanyi Bissek Anne-Cecile
Faculty of Health Sciences, University of Buea, Buea P.O. Box 63, Cameroon.
Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon.
Biomedicines. 2024 Sep 12;12(9):2083. doi: 10.3390/biomedicines12092083.
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 < 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%, < 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, < 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.
儿童死亡占全球所有艾滋病相关死亡的15%，喀麦隆儿童的负担更高（25%），这可能是由病毒学反应不佳导致的。我们试图评估在接受抗逆转录病毒治疗（ART）的具有全国代表性的儿科和青年人群中病毒抑制（VS）情况及其决定因素。在喀麦隆儿童（<10岁）、青少年（10 - 19岁）和青年（20 - 24岁）中开展了一项横断面多中心研究。数据于2023年12月至2024年3月从9个参考实验室的数据库中收集。构建了一个条件向后逐步回归模型来评估VS的预测因素，VS定义为病毒载量（VL）<1000 HIV - RNA拷贝/mL。总体而言，分析了7558名个体（女性：73.2%）。关于ART方案，17%的儿童、80%的青少年和83%的青年转换为基于多替拉韦（DTG）的方案。总体VS率为82.3%，其中<10岁组为67.3%，10 - 19岁组为80.5%，20 - 24岁组为86.5%，P<0.001。基于DTG的方案的VS率为85.1%，而依非韦伦/奈韦拉平方案为80.0%，洛匹那韦/利托那韦或阿扎那韦/利托那韦方案为65.6%。女性的VS率高于男性（85.8%对78.（此处原文有误，应为78.%）2%，P<0.001）。在开始ART后的12个月和24个月时，VS率在85%左右保持稳定，但在36个月时降至约80%，P<0.009。未实现VS的独立预测因素为年龄较小、ART疗程较长（>36个月）、主干药物（非替诺福韦酯/拉米夫定）和锚定药物（非基于DTG）。在这个向DTG转换程度不同的喀麦隆儿科人群中，总体VS仍低于95%的目标。未实现VS的预测因素为年龄较小、非替诺福韦酯/拉米夫定和非基于DTG的方案。因此，在这个新的ART时代，消除儿童艾滋病的努力应优先考虑向基于DTG的方案转换。
