Impact of optimized antiretroviral therapy on virological and nutritional outcomes among HIV infected adolescents in Cameroon

BACKGROUND: Optimization of antiretroviral therapy (ART) is one of the key recommendations of the World Health Organization (WHO) since 2019 to achieve 95% viral suppression. The transition to optimized therapeutic regimens (OTRs) in pediatrics began in Cameroon at 2020. The objective of our study was to evaluate the impact of OTRs on HIV-infected adolescents (HIA) in healthcare facilities in the city of Douala. METHODS: A multicenter cross-sectional study was conducted from February to June 2022 in five hospitals in Douala. All HIA aged 10-19 years receiving ART for at least six months were included. Sociodemographic, clinical, therapeutic, and data related to the transition to optimized regimens were collected. Statistical analyses were performed using SPSS version 25. A p-value < 0.05 was considered statistically significant. RESULTS: Out of the 613 adolescents on antiretroviral therapy (ART), 599 (97.7%) were included in the study at a median age of 15 years (interquartile range [IQR]: 13-18 years). The male-to-female ratio was 0.9, and most adolescents (94.0%) had acquired HIV through mother-to-child transmission. Among the 599 HIV-infected adolescents (HIV), 391 (65.3%) were receiving optimized therapy, with a mean ART duration of exposure of 11.6 ± 5.7 months. Before switching to optimized therapy, 329 adolescents (84.2%) had viral suppression, compared to 370 (94.6%) after switching. Adolescents receiving optimized antiretroviral therapy were significantly 3.3 times more likely to have viral load suppression (OR: 3.3; 95% CI: 2.0-5.6; p < 0.001). These optimized regimens significantly reduced moderate malnutrition (OR: 0.38; 95% CI: 0.16-0.91; p = 0.042) and improved nutritional status, with mean weight increasing from 43.2 ± 13.0 kg to 46.7 ± 13.3 kg (p < 0.001) and body mass index increasing from 18.8 ± 3.2 to 19.6 ± 3.0 kg/m² (p < 0.001). CONCLUSION: Optimized antiretroviral regimens significantly improved viral suppression and moderate malnutrition among HIV infected adolescents in Douala, Cameroon.