Plasma Viral Load of 200 Copies/mL is a Suitable Threshold to Define Viral Suppression and HIV Drug Resistance Testing in Low- and Middle-Income Countries: Evidence From a Facility-Based Study in Cameroon

被引：0

作者：

Chenwi, Collins Ambe ^{[1
,2
]}

Nayang Mundo, Rachel Audrey ^{[1
,3
]}

Nka, Alex Durand ^{[1
,2
,4
]}

Semengue, Ezechiel Ngoufack Jagni ^{[1
,2
,4
]}

Beloumou, Grace Angong ^{[1
]}

Ka'e, Aude Christelle ^{[1
,2
]}

Togna Pabo, Willy Leroi ^{[1
,5
]}

Takou, Desire ^{[1
]}

Abba, Aissatou ^{[1
]}

Djupsa, Sandrine Claire ^{[1
]}

Molimbou, Evariste ^{[1
,2
,4
]}

Etame, Naomi-karell ^{[1
,6
]}

Kengni Ngueko, Aurelie Minelle ^{[1
,2
]}

Same, David Kob ^{[7
,8
]}

Bouba Pamen, Jolle Nounouce ^{[6
,7
,9
]}

Abah Abah, Aristide Stephane ^{[9
]}

Billong, Serge Clotaire ^{[6
,7
]}

Ajeh Awoh, Rogers ^{[10
]}

Halle-Ekane, Gregory Edie ^{[5
]}

Cappelli, Giulia ^{[11
]}

Njom-Nlend, Anne-Esther ^{[12
]}

Zk Bissek, Anne-Cecile ^{[6
,13
]}

Temfack, Elvis ^{[14
]}

Santoro, Maria Mercedes ^{[2
]}

Ceccherini-Silberstein, Francesca ^{[2
]}

Colizzi, Vittorio ^{[1
,3
,4
]}

Kaseya, Jean ^{[14
]}

Ndembi, Nicaise ^{[14
,15
]}

Ndjolo, Alexis ^{[1
,6
]}

Perno, Carlo Federico ^{[1
,2
,16
]}

Fokam, Joseph ^{[1
,5
,6
,7
,10
]}

机构：

[1] Chantal BIYA Int Reference Ctr Res HIV AIDS Preven, Yaounde, Cameroon

[2] Univ Roma Tor Vergata, Rome, Italy

[3] Protestant Univ Cent Africa, Yaounde, Cameroon

[4] Evangelic Univ Cameroon, Bandjoun, Cameroon

[5] Univ Buea, Fac Hlth Sci, Buea, Cameroon

[6] Univ Yaounde I, Fac Med & Biomed Sci, Yaounde, Cameroon

[7] Minist Publ Hlth, Natl HIV Drug Resistance Grp, Yaounde, Cameroon

[8] UNAIDS, Yaounde, Cameroon

[9] Minist Publ Hlth, Dept Dis Epidem & Pandem Control, Yaounde, Cameroon

[10] Minist Publ Hlth, Natl AIDS Control Comm, Cent Tech Grp, Yaounde, Cameroon

[11] Natl Res Council Council, Ottawa, ON, Canada

[12] Univ Douala, Higher Inst Med Technol, Fac Med & Pharmaceut Sci, Yaounde, Cameroon

[13] Minist Publ Hlth, Div Hlth Operat Res, Yaounde, Cameroon

[14] Africa Ctr Dis Control & Prevent ACDC, Headquarter, Addis Ababa, Ethiopia

[15] Inst Human Virol, Baltimore, MD USA

[16] Bambino Gesu Pediat Hosp Rome Italy, Rome, Italy

来源：

JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PROVIDERS OF AIDS CARE | 2024年 / 23卷

关键词：

HIV; low-level viremia; genotype; antiretroviral resistance; Cameroon; LOW-LEVEL VIREMIA; ANTIRETROVIRAL THERAPY; HIV-1-INFECTED PATIENTS; VIROLOGICAL FAILURE; CLINICAL-RELEVANCE; PREVALENCE; EVOLUTION; OUTCOMES; NAIVE; FEASIBILITY;

D O I：

10.1177/23259582241306484

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Introduction: In low-and-middle-income-countries (LMIC), viral suppression is defined as plasma viral load (PVL) below 1000 copies/mL (low-level viremia [LLV]) and threshold for HIV drug resistance (HIVDR) testing. However, there is evidence that drug resistance mutations (DRMs) may emerge at LLV, thus compromising antiretroviral treatment (ART) response. We evaluated sequencing success rates (SSR) at LLV, described HIVDR profiles and adequacy with potential efficacy of tenofovir-lamivudine-dolutegravir (TLD). Methods: A cross-sectional study was conducted among individuals with LLV at the Chantal BIYA International Reference Centre, Yaound & eacute;, Cameroon from January 2020 through August 2021. HIV-1 sequencing was performed on protease/reverse-transcriptase, and sequences analysed using Stanford HIVdbv9.5. SSR and HIVDR rates were assessed according to viral-load ranges, with P < .05 considered statistically significant. Results: In total, 131 individuals were enrolled (median [IQR] age = 41 [30-49] years; 67.9% female; 54.7% at WHO clinical-stage I/II; median ART-duration 7 [4-11] years; median CD4-count 221 [103-402] cells/mm3 and median PVL 222 [96-436] copies/mL). Overall, SSR at LLV was 34.4% (45/131) and increased significantly with decreasing-age (P = .002) and increasing-PVL (P = .017). SSR were doubled at PVL >= 150 copies/mL (21.8% at [40-150] vs. 43.3% at [150-1000]; OR = 2.8, P = .01). Of the 45 sequences obtained, 75.6% were recombinant strains (CRF02_AG, CRF09_cpx, CRF11_cpx) and 24.4% pure-subtypes (A1, D, F2, G). Overall, HIVDR prevalence at LLV was 82.2% (37/45), with 74.6% and 15.6% resistance to reverse-transcriptase inhibitors (RTIs) and ritonavir-boosted protease inhibitors (PI/r) respectively. Interestingly, HIVDR rates were similar at PVLs [50-200] versus [200-1000] copies/mL (P = .69). The most frequent DRMs were M184 V (73.3%) and K103N (40.0%) for RTIs and M46I (6.7%) for PIs/r. Overall 55.6% (25/45) of individuals were on suboptimal ART (needing ART-optimisation), with 48.9% (22/45) having suboptimal TLD predictive efficacy. Optimisation need was higher in first-line (81.8%, P = .03), but similar across viral clades and PVL-ranges (P = .6). Conclusion: In this LMIC context, sequencing for HIVDR is feasible at LLV even with broad HIV-1 diversity, with significantly higher SSR above 150 copies/mL and/or in paediatrics. About 80% of individuals with LLV harbour HIVDR strains, with half of them needing ART optimisations to limit HIVDR emergence and prevent treatment failure. Our findings underscore the clinical benefits of HIVDR during persisting LLV and the need to reconsider the threshold for viral suppression around 200copies/mL in LMICs.

引用

页数：12

共 2 条

[1] "Treatment access cascades": effects of viral load, resistance testing and safety in pregnancy on access to dolutegravir in low- and middle-income countries
Levi, J.
Clayden, P.
Hill, A.
JOURNAL OF THE INTERNATIONAL AIDS SOCIETY, 2018, 21
[2] Evaluation of new high-throughput platforms for the quantification of HIV-1 RNA in plasma to support scale-up of viral load testing in low- and middle-income countries
Zhang, G.
Hans, L.
Jadczak, S.
Sleeman, K.
Makuwaza, L.
Peloakgosi-Shikwambani, K.
Cox, M. Hurlston
Alexander, H.
Carmona, S.
Zeh, C.
JOURNAL OF THE INTERNATIONAL AIDS SOCIETY, 2021, 24 : 25 - 25

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