Laboratory Based Surveillance of HIV-1 Acquired Drug Resistance in Cameroon: Implications for Use of Tenofovir-Lamivudine-Dolutegravir (TLD) as Second- or Third-Line Regimens

Increased HIV drug resistance (HIVDR) with antiretroviral therapy (ART) rollout may jeopardize therapeutic options, especially in this era of transition to fixed-dose tenofovir-lamivudine-dolutegravir (TLD). We studied acquired HIVDR (ADR) patterns and describe potentially active drugs after first- second-line failure resource-limited settings (RLS) like Cameroon. A laboratory-based study 759 patients (≥15 years) experiencing virological was carried out at the Chantal Biya International Reference Centre (CIRCB), Yaoundé, Socio-demographic, immunovirological data from patient records were analysed according HIV-1 genotypic profiles. Median (IQR) ART-duration 63 (50–308) months. CD4 viremia 153 (IQR:50–308) cells/mm3 138,666 (IQR:28,979–533,066) copies/mL, respectively. Overall ADR high (93.4% first-line; 92.9%-second-line). TDF, 35.7% participants first-line 45.1% second-line, suggested sub-optimal TLD-efficacy (64.3%) third-line (54.9%). All PI/r preserved efficacy while only DRV/r high-level (87.9%) failure. In setting (RLS), is ART-failing patients. strategies remain potent backbones for ART, remains very despite Though TLD use would be preferable, blind second- regimens (functional monotherapy dolutegravir) risk further failure, thus suggesting selective ART switch failing RLS.