Viral suppression in the context of SARS-CoV-2 among children infected with HIV-1 monitored in five health facilities in Benin

Monitoring the effectiveness of antiretroviral treatment by measuring viral load is a strong recommendation from the WHO following the intensification of this therapy, which, if well managed, improves patients' quality of life. In children, treatment options are limited and virological non-suppression is high. Virological suppression among children living with HIV who were followed at care facilities during the SARS-CoV-2 pandemic is poorly documented in countries with intermediate resources, such as Benin. Methods A longitudinal study was carried out from November 20, 2020, among children under 15 years of age who had been receiving ART for at least six months in five healthcare facilities. TCD4 lymphocytes (LTCD4) count was performed using the CyFlow counter II (from Partec laboratories). Viral load was performed using the Abbott RealTime HIV-1 assay (Abbott Molecular, Inc.). The linear range of 40-10.000.000 copies/ml and a detection limit of 40 copies/ml were defined by the manufacturers. Virological success was assessed as a suppressed viral load (VL < 3log₁₀). For children whose VL₁ ≥ 3log₁₀, WHO 2016 recommendations were applied and therapeutic education sessions were offered for 3 months, after which VL₂ was measured. Children whose (VL₁ and VL₂) ≥ 3log₁₀ were considered not suppressed. Results The mean age of 305 children enrolled was 110 (SD 41.25) months, with a predominance of girls at 52.8% (161/305). The median LTCD4 at study starting was 814 [IQR 544-1118] cells/µl. Overall, 73.11% (223/305) of children achieved virological success at the first viral load measurement, compared to 79.63% (219/275) at the second (03 months after the first). Between the two measurements, 9.83% (30/305) of children did not keep their medical appointments due to SARS-CoV-2 pandemic restrictions. Also, 20.73% (17/82) of non-suppressed children at VL₁ went undetectable. Among the 17.1% (47/275) of unsuppressed children, 10.64% (5/47) were on integrase strand transfer inhibitors as DTG (Dolutegravir). Conclusion This study, conducted in children on ART during the SARS-CoV-2 pandemic, highlighted a high rate of retention in care and viral suppression. However, there are challenges in achieving the UNAIDS third 95 to ensure sustainable viral suppression in children.