Virological Suppression Rate and Drug Resistance in Children and Adolescents Receiving Dolutegravir-Containing Antiretroviral Therapy in Ndop Health District, Cameroon.

Abstract

Objectives: This study aimed at evaluating the rate of virological suppression and profiles of HIV-1 drug resistance in HIV-positive children and adolescents taking Dolutegravir-based antiretroviral therapy in the Ndop health district of Cameroon.

Methods: This hospital-based, cross-sectional study was carried out from February to May 2025. Children and adolescents (5-19 years) living with HIV-1, who had been taking Dolutegravir-based regimens for at least a year, were included in the study. Participants with virological failure (viral load > 1000 copies/mL) underwent HIV-1 genotypic resistance testing (RNA extraction, cDNA synthesis, nested PCRs and Sanger sequencing) targeting the reverse transcriptase and integrase regions of the pol gene. Mutations were interpreted using the Stanford HIV drug resistance database.

Results: Out of 82 eligible participants receiving Tenofovir-Lamivudine-Dolutegravir (TLD) regimen, 75 (91.5%) achieved virological suppression (VL < 1000 copies/mL). Among 7 virally unsuppressed individuals, 5 (6.1%) were successfully genotyped. The major integrase resistance mutation G140GRS was detected in one participant (1/5; 20%). Univariate analysis to identify potential risk factors associated with drug resistance revealed no statistically significant associations. However, it was observed that major or accessory DRMs were more common in males, participants in secondary school and those taking antiretroviral drugs for a duration of 3-5 years.

Conclusions: The TLD regimen remains highly effective in viral suppression, with very low resistance rates observed. Targeted adherence support for high-risk adolescents like those in secondary school is critical to preserve treatment efficacy.