Determinants of virological failure in HIV-infected children and adolescents on first-line anti retrovirals in three treatment centres in the Bamenda municipality, Cameroon

Virological failure is defined as a plasma viral load above 1000 copies/ml in a human immunodeficiency virus (HIV) patient after two consecutive viral load measurements 3 months apart, with adherence support after the first test and being on treatment for at least 6 months. It can lead to disease progression and increased risk of opportunistic infections. We conducted a retrospective cohort study using data from medical records of children and adolescents aged 6 weeks to 19 years receiving first-line antiretrovirals (ARVs) at three treatment centres in Bamenda: the Regional Hospital, Nkwen District Hospital, and St Mary Soledad Catholic Hospital. Data were collected over a 5-month period (January to May 2025) and included patients with at least 6 months on ART and two documented viral load measurements taken three months apart. Of 419 patients recruited, 169 had virological failure, giving a prevalence of 40.3%, with most being male (53.8%). The factors associated with virological failure included being male (aOR = 0.54; P < .008), having a caregiver who is single (aOR = 3.36; P < 0.001), having WHO clinical stage 3 and 4 at ARV initiation (aOR = 3.38; P = .038), fair or poor adherence to ARVs (aOR = 15.73; P < 0.001) and greater than 10 missed appointments (aOR = 33.76; P < .001). A total of 14 children and adolescents with virological failure died, resulting in a mortality rate of 8.3%. This study shows that the prevalence of virological failure was high in the three HIV treatment centres in this part of Cameroon.