Challenges in Achieving Viral Suppression Among Adolescents and Young Adults Under a Dolutegravir-Based Regimen: Living with HIV in Gabon

Background: Children, adolescents and young adults living with HIV represent a vulnerable population. Achieving viral suppression in this population remains a major challenge in sub-Saharan Africa. Methods: We conducted a cross-sectional study among HIV-positive individuals aged 0–24 years in Gabon. Data were collected, including viral load (VL), CD4 counts, and immunosuppression levels. Viral suppression was defined as VL < 1000 copies/mL. Statistical comparisons across age groups and immunosuppression categories were performed. Results: Of the 130 (100%) participants included, 59 (45.4%) were males and 71 (54.6%) females. Overall, 72 (55.4%) achieved viral suppression, while 58 (44.6%) remained uncontrolled. Viral suppression increased with age (23.8% (5/21) in 0–7 years; 29.2% (14/48) in 8–15 year and 42.6% (26/61) in 16–24 years), yet uncontrolled VL were predominant across all groups. Median VL values were low but showed wide interquartile ranges, indicating heterogeneity in viral control. Mean CD4 counts declined significantly with age (780 in 0–8 years vs. 470 in 16–24 years; p = 0.001). Immunosuppression levels correlated inversely with virological control (p < 0.001). Conclusions: Despite moderate overall viral suppression, nearly half of adolescents and young adults failed to achieve virological control. The decline in CD4 counts with age highlights increased vulnerability in this population.