Low Rates of Virologic Failure and Acquired HIV-1 Drug Resistance Among Children in Cameroon: Evidence Following Transition to Dolutegravir-based Regimens in Pediatrics

BACKGROUND: Virologic failure (VF) in children living with HIV (CLHIV) remains challenging in sub-Saharan Africa, reaching alarming rates in Cameroon. We sought to evaluate predictors of virologic response and HIV drug resistance (HIVDR) among CLHIV in Cameroon during the introduction of pediatric dolutegravir (pDTG)-based antiretroviral therapy (ART). METHODS: We conducted a facility-based longitudinal study from November 2022 through April 2023 among CLHIV (age 0-10 years) attending the Chantal BIYA Foundation's Mother and Child Centre in Yaoundé-Cameroon. Plasma viral load (PVL) and HIVDR were evaluated, with VF defined as 2 consecutive PVL ≥1000copies/mL under active adherence counseling/support. RESULTS: Overall, the 318 enrolled participants had a median (interquartile range) age of 8 (6-9) years and 162/318 (50.9%) girls. Most (299/318, 94.03%) received pDTG-based ART and mean ART duration was 5.6 ± 2.6 years. At enrollment, 37 (11.6%) children were virally unsuppressed (PVL≥1000copies/mL), with higher odds among children from rural areas ( P = 0.018) and among those reporting poor adherence ( P < 0.001). After active adherence counseling and support, 30/37 (81.1%) children were resampled after 1 month and 3 remained unsuppressed, indicating <1% (3/311) with VF overall. Among those experiencing VF, HIVDR mutations were found in <1% (2/311) children [L74V(1/3), K103N(1/3), M184V(2/3), P225H(1/3)]. CONCLUSIONS: Virologic response among children receiving pDTG-containing ART was strong in Cameroon. Combining robust ART regimens with active adherence support can advance sustained progress towards HIV elimination in children by 2030 in sub-Saharan Africa.