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  • PA-352 Detectable low-level viremia among people living with HIV in Cameroon suggests a revised threshold for viral suppression: evidence in the era of dolutegravir-based ART

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PA-352 Detectable low-level viremia among people living with HIV in Cameroon suggests a revised threshold for viral suppression: evidence in the era of dolutegravir-based ART
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  1. Alex Durand Nka1,
  2. Joseph Fokam1,
  3. Collins Ambe Chenwi1,
  4. Efakaki Gabisa Jeremiah1,
  5. Flore Yollande Mamgue Dzukam1,
  6. Yagai Bouba2,
  7. Michel Carlos Tommo Tchouaket1,
  8. Ezechiel Ngoufack Jagni Semengue1,
  9. Desire Takou1,
  10. Sylvie Moudourou1,
  11. Nadine Fainguem1,
  12. Willy Pabo1,
  13. Aurelie Minelle Kengni Ngueko1,
  14. Junie Flore Yimga1,
  15. Krystel Marie Nnomo Zam1,
  16. Rachel Kamgaing1,
  17. Charlotte Tangimpundu1,
  18. Nelly Kamgaing1,
  19. Anne-Esther Njom-Nlend3,
  20. Rogers Ajeh2,
  21. Etienne Kembou4,
  22. Lifanda Ebiama Lifanda2,
  23. Bouba Pamen4,
  24. Alice Ketchaji5,
  25. Edith Temgoua2,
  26. Serge Clotaire Billong6,
  27. Anne-Cecile Z-K Bissek7,
  28. Hamsatou Hadja2,
  29. Edie GE Halle8,
  30. Vittorio Colizzi1,
  31. Samuel Martin Sosso1,
  32. Alexis Ndjolo1
  1. 1Chantal Biya International Reference Centre For Research On Hiv/aids Prevention And Management (circb), Cameroon
  2. 2Central Technical Group, National AIDS Control Committee, Cameroon
  3. 3Higher Institute of Medical Technology, Cameroon
  4. 4World Health Organisation Afro, country office, Cameroon
  5. 5Division of Disease, Epidemic and Pandemic Control, Ministry of Public Health, Cameroon
  6. 6National HIV drug resistance working group, Cameroon
  7. 7Division of Health Operational Research, Ministry of Public Health, Cameroon
  8. 8Faculty of Health Sciences, University of Buea, Cameroon

Abstract

Background Transitioning to dolutegravir-based therapy in Cameroon has improved viral suppression (VS) rates, known as low-level viremia (LLV) <1000copies/ml. However, there is a growing number of patients experiencing VS with detectable LLV, indicating risk of virological failure. This study aimed to characterize the distribution of LLV and associated factors in the Cameroonian context.

Methods A laboratory-based study was conducted among treatment-experienced patients monitored for HIV plasma viral load (PVL) from January 2020 through April 2022 at the Chantal BIYA International Reference Centre (CIRCB), Yaoundé-Cameroon. PVL was measured using the Abbott m2000RT-PCR. Among patients with LLV, levels of PVL were stratified into 4 cut-points: <50, 50–200, 201–500, and 501–999 copies/ml, with p<0.05 considered statistically significant.

Results Overall, 14970 patients were enrolled: 72.5% were female; 14219 adults, 466 adolescents, 285 children. By ART-regimens, 3411 were on NNRTI-based, 505 on PI/r-based and 11054 on DTG-based ART. Median [IQR] duration on ART was 36[27–39] months. Overall VS (<1000 copies/ml) rate was 88.8% (13291/14970) (95% CI: 88.2–89.3), and stratification in this population showed 1.5% (207/13291) with 501–999 copies/ml, 3.3% (445/13291) with 200–500 copies/ml, 10.8% (1439/13291) had 50–200 copies/ml, and 84.2% (11200/13291) with <50 copies/ml, p<0.0001. By ART-regimens, detectable LLV (50–999copies/ml) was 13.9% (1540/11054) with DTG-containing versus 14.1% (551/3916) with other ART-regimens, p=0.81. By age, detectable LLV was 13.8% among adults versus 16.9% mchildren/adolescents, p=0.01. Most importantly, the trend overtime of detectable LLV between 50–200 copies/ml increased significantly from 65.2% (534/819) in 2020, 70.7% (678/958) in 2021 and 72.2% (227/314) in 2022, p=0.001.

Conclusion Even though VS rate appears encouraging, there is a significant increasing proportion of patients with detectable LLV in this DTG-era. Of note, LLV with 50–200 copies appears highly predominant, suggesting a revision of threshold for VS at a maximum of 200 copies/ml in resource-limited settings like Cameroon.

https://doi.org/10.1136/bmjgh-2023-EDC.168

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