Conference abstract
Evaluation of circulating and archived HIV-1 integrase drug-resistance variants among patients on third-line art in Cameroon: implications for Dolutegravir-containing regimens in resource-limited settings
Pan African Medical Journal - Conference Proceedings. 2023:18(134).03
Oct 2023.
doi: 10.11604/pamj-cp.2023.18.134.2244
Archived on: 03 Oct 2023
Contact the corresponding author
Keywords: Archived-resistance, third-line ART, dolutegravir, raltegravir, Cameroon
Oral presentation
Evaluation of circulating and archived HIV-1 integrase drug-resistance variants among patients on third-line art in Cameroon: implications for Dolutegravir-containing regimens in resource-limited settings
Joseph Fokam1,&, Ezechiel Ngoufack Jagni Semengue1, Evariste Molimbou1, Naomi-Karell Etame1, Maria Mercedes Santoro2, Désiré Takou1, Leonella Mossiang3, Alain Patrice Meledie4, Collins Ambe Chenwi1, Bouba Yagai1, Alex Durand Nka1, Beatrice Dambaya1, Georges Teto1, Aude Christelle Ka’e1, Grâce Angong Beloumou1, Sandrine Claire Djupsa Ndjeyep1, Nadine Fainguem1, Aissatou Abba1, Aurelie Minelle Ngueko Kengni1, Michel Carlos Tommo Tchouaket1, Nounouce Pamen Bouba5, Serge-Clotaire Billong5, Rina Djubgang6, Edith Temgoua Saounde7, Samuel Martin Sosso1, Charles Kouanfack3, Anne-Cecile Zoung-Kanyi Bissek5, Emmanuel Eben-Moussi1, Vittorio Colizzi2, Carlo-Federico Perno1, Francesca Ceccherini-Silberstein2, Alexis Ndjolo1
1Chantal BIYA International Reference Centre for Research on HIV/AIDS Management and Care, Yaoundé, Cameroun, 2University of Rome Tor Vergata, Rome, Italy, 3Yaoundé Central Hospital, Yaoundé, Cameroun, 4Douala General Hospital, Douala, Cameroon, 5Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroun, 6Directorate of Pharmacy, Drug and Laboratory, Ministry of Public Health, Yaoundé, Cameroun, 7Central Technical Group, National AIDS Control Committee, Yaoundé, Cameroun
&Corresponding author
Introduction: to ensure the long-term efficacy of dolutegravir (DTG), we evaluated the genotypic resistance profile in viral reservoirs among third-line (3L) patients in Cameroon, according to prior exposure to raltegravir (RAL). The objective was to characterize the patterns of INSTI-DRMs in viral reservoirs of patients on third-line DTG-containing regimens according to previous exposure to RAL in Cameroon
Methods: a facility-based study was conducted from May through December 2021, among patients on 3L from HIV treatment centres in Yaoundé and Douala. Plasma viral load was measured, and genotyping was performed on plasma-RNA and pro-viral DNA. HIV-1 drug resistance mutations were interpreted using HIVdb.v9.1 and phylogeny was performed using MEGA.v7, with p<0.05 considered statistically significant.
Results: of the 12,093 patients on ART, 97 were in 3L and only 53 fully met our inclusion criteria. The median [IQR] age was 51 [40-55] years and the M/F sex ratio was 4/5. Median [IQR] viremia at 3L initiation was 3,795 [220-169,322] copies/ml while CD4-count was 157 [84-285] cells/mm3. The overall median duration on ART was 192 [162-222] months. Regarding 3L, 15.09% (8/53) were exposed to RAL. Only 5.66% (3/53) had unsuppressed viremia (>1000 copies/ml), Resistance testing in pro-viral DNA was successful for 18/22 participants and revealed 1/18 patient (5.56%, in the RAL-arm) with archived mutations at major resistance positions (G140R, G163R).
Conclusion: in Cameroon, 3L-experienced patients have a good virological response with a low level of archived mutations in the integrase. This finding underscores the use of DTG-containing ART for heavily-treated patients in similar programmatic settings. However, patients with prior exposure to RAL should be closely monitored following a stratified or personalized approach to mitigate risks of INSTI-resistance, alongside pharmacovigilance.
Evaluation of circulating and archived HIV-1 integrase drug-resistance variants among patients on third-line art in Cameroon: implications for Dolutegravir-containing regimens in resource-limited settings
Joseph Fokam1,&, Ezechiel Ngoufack Jagni Semengue1, Evariste Molimbou1, Naomi-Karell Etame1, Maria Mercedes Santoro2, Désiré Takou1, Leonella Mossiang3, Alain Patrice Meledie4, Collins Ambe Chenwi1, Bouba Yagai1, Alex Durand Nka1, Beatrice Dambaya1, Georges Teto1, Aude Christelle Ka’e1, Grâce Angong Beloumou1, Sandrine Claire Djupsa Ndjeyep1, Nadine Fainguem1, Aissatou Abba1, Aurelie Minelle Ngueko Kengni1, Michel Carlos Tommo Tchouaket1, Nounouce Pamen Bouba5, Serge-Clotaire Billong5, Rina Djubgang6, Edith Temgoua Saounde7, Samuel Martin Sosso1, Charles Kouanfack3, Anne-Cecile Zoung-Kanyi Bissek5, Emmanuel Eben-Moussi1, Vittorio Colizzi2, Carlo-Federico Perno1, Francesca Ceccherini-Silberstein2, Alexis Ndjolo1
1Chantal BIYA International Reference Centre for Research on HIV/AIDS Management and Care, Yaoundé, Cameroun, 2University of Rome Tor Vergata, Rome, Italy, 3Yaoundé Central Hospital, Yaoundé, Cameroun, 4Douala General Hospital, Douala, Cameroon, 5Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroun, 6Directorate of Pharmacy, Drug and Laboratory, Ministry of Public Health, Yaoundé, Cameroun, 7Central Technical Group, National AIDS Control Committee, Yaoundé, Cameroun
&Corresponding author
Introduction: to ensure the long-term efficacy of dolutegravir (DTG), we evaluated the genotypic resistance profile in viral reservoirs among third-line (3L) patients in Cameroon, according to prior exposure to raltegravir (RAL). The objective was to characterize the patterns of INSTI-DRMs in viral reservoirs of patients on third-line DTG-containing regimens according to previous exposure to RAL in Cameroon
Methods: a facility-based study was conducted from May through December 2021, among patients on 3L from HIV treatment centres in Yaoundé and Douala. Plasma viral load was measured, and genotyping was performed on plasma-RNA and pro-viral DNA. HIV-1 drug resistance mutations were interpreted using HIVdb.v9.1 and phylogeny was performed using MEGA.v7, with p<0.05 considered statistically significant.
Results: of the 12,093 patients on ART, 97 were in 3L and only 53 fully met our inclusion criteria. The median [IQR] age was 51 [40-55] years and the M/F sex ratio was 4/5. Median [IQR] viremia at 3L initiation was 3,795 [220-169,322] copies/ml while CD4-count was 157 [84-285] cells/mm3. The overall median duration on ART was 192 [162-222] months. Regarding 3L, 15.09% (8/53) were exposed to RAL. Only 5.66% (3/53) had unsuppressed viremia (>1000 copies/ml), Resistance testing in pro-viral DNA was successful for 18/22 participants and revealed 1/18 patient (5.56%, in the RAL-arm) with archived mutations at major resistance positions (G140R, G163R).
Conclusion: in Cameroon, 3L-experienced patients have a good virological response with a low level of archived mutations in the integrase. This finding underscores the use of DTG-containing ART for heavily-treated patients in similar programmatic settings. However, patients with prior exposure to RAL should be closely monitored following a stratified or personalized approach to mitigate risks of INSTI-resistance, alongside pharmacovigilance.
