The mother-to-child transmission of HIV-1 and profile of viral reservoirs in pediatric population: A systematic review with meta-analysis of the Cameroonian studies

Abstract

Background The mother-to-child transmission of HIV-1 (MTCT) remains on the major route of HIV-transmission among pediatric populations in Africa. Though a prevention of MTCT (PMTCT) high-priority country, data on the MTCT burdens in Cameroon remains fragmented. Objective We sought to assess the pooled MTCT rate, its risk-factors, and to characterize viral reservoirs of infected-children in Cameroon. Methods All relevant observational cohort and cross-sectional studies conducted in Cameroon were searched from PubMed, African Journals Online, Google scholar, ScienceDirect and academic medical education databases. Heterogeneity and publication bias were respectively assessed by the I2 statistic and the Egger/funnel plot test. Meta-analysis was performed using the random effects model. MTCT rate >5% was considered as “high”. This review was registered in the Prospero database, CRD42021224497. Results We included a total of 29 studies and analyzed 46 684 children born from HIV-positive mothers. The overall rate of MTCT was 7.00% (95% CI = 6.07–8.51). According to regions, the highest burden was in Adamaoua-region (17.51% [95% CI:14.21–21.07]) with only one study found. PMTCT option-B+ resulted in about 25% reduction of MTCT (8.97% [95% CI: 8.71–9.24] without option-B+ versus 2.88% [95% CI: 5.03–9.34] with option-B+). Regarding risk-factors, MTCT was significantly associated with the absence of PMTCT-interventions both in children (OR:5.40 [95% CI: 2.58–11.27]) and mothers (OR: 3.59 [95% CI: 2.15–5.99]). Regarding viral reservoirs, a pro-viral DNA mean of 3.34±1.05 log10/mL was observed among 5/57 children and archived HIV drug resistance mutations were identified in pro-viral DNA marker among 21/79 infected-children. Conclusion In spite of the dropdown in MTCT following option-B+ implementation, MTCT remains high in Cameroon, with substantial disparities across regions. Thus, in this era of option-B+, achieving MTCT elimination requires interventions in northern-Cameroon. The variation in pro-viral load in infected-children underlines the relevance of characterizing viral reservoirs for possible infection control in tropical settings.

Evaluation of HIV-1 DNA levels among adolescents living with perinatally acquired HIV-1 in Yaounde, Cameroon: A contribution to paediatric HIV cure research in Sub-Saharan Africa

“…With a goal to contribute and address one of the key research goals of the International AIDS Society Global Scientific Strategy 2021 and supporting efforts towards the elimination of AIDS as a pandemic by 2030, the present study provides insights into the quantitative characterization of total HIV-1 DNA in a typical SSA country like Cameroon. Given the framework of ART and the high burden of paediatric HIV-1 infection within this SSA setting, 30 it represents a unique land of opportunities for setting up baseline investigations that could pave the way for paediatric HIV-1 functional cure research.…”

“…The decay dynamics of HIV-1 DNA during early ART (within the first 12 weeks of life) in infants has been described previously, 41 , 42 , 43 , 44 reinforcing the need of very early ART initiation in a context where perinatal transmission of HIV-1 is still of concern. 30 Additionally, the CHER study has shown that a long duration on ART significantly decrease HIV-1 DNA levels in paediatric populations. 13 …”

Growth of infants delivered by mothers with HIV in Guangxi, China: An 18‐month longitudinal follow‐up study, 2015–2021

“…In the absence of interventions, mother-to-child transmission of HIV ranges from 15% to 45%; in the non-breastfeeding population, this rate can be reduced to <2% with effective interventions during pregnancy and childbirth [12]. Despite the global success of PMTCT, some pregnant women with HIV are not diagnosed until the third trimester or even during childbirth, and so do not receive effective PMTCT interventions [13,14]. Hence, the growth and development of infants born to mothers with HIV and the genetic subtypes and drug resistance of infants with HIV deserves attention.…”

Inflammatory profile of vertically HIV-1 infected adolescents receiving ART in Cameroon: a contribution toward optimal pediatric HIV control strategies

“…With the goal to contribute to the control of pediatric HIV-infection in the era of ART and to further support the UNAIDS agenda for research into a functional HIV cure in SSA, the present study has provided new insights on the expression of inflammatory (IL-1β, IL-6, IL-12, CCL2, CCL3, CCL4, IFNγ, IL-17A and TNFα), anti-inflammatory (IL-4 and IL-10), and inflammation-related (Il-6 and TGF-β1) cytokines/chemokines in APHI in a typical SSA setting like Cameroon. Taking into consideration the ART paradigm and the high burden of pediatric HIV-infection in SSA settings like Cameroon ( 4 , 9 ), this setting represents an ideal avenue for setting up baseline investigations that could pave the way for pediatric HIV cure research in this sub-region.…”

“…Of note, sub-Saharan Africa (SSA) is paying the heaviest toll of pediatric HIV as ~85% of worldwide new pediatric infections occur in this region ( 2 ). Even though ART has substantially contributed to reducing HIV-1 MTCT ( 3 ), women in SSA settings (Cameroon included) ( 4 ) still face delayed HIV-1 diagnosis during pregnancy/breastfeeding, which leads to limited coverage in prevention of MTCT (PMTCT) and occurrence of new pediatric HIV-1 infections ( 5 ),…”