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Population : 6,934,169 inhabitants 6 Sanitary regions UNAIDS (2014) - HIV prevalence : 2.5% = 110,000 PLHIV - Higher prevalence in southern regions - PLVIH on ART : 37, Children on ART : 2, % 3% 3.2% 3% 0.6% Kara Lomé 7.6% BENIN GHANA BURKINA FASO 4

2008 : Free access to ART started 2009: HIV Early Infant Diagnosis implemented 2013: NAIDS program advocates 1 VL test per PLHIV on ART per year Findings: VL testing is often lacking in the country Outcome ? - Virological failure ? - Emergence of Drug Resistance Mutations? What about people on ART ? children and adolescents especially children and adolescents 5

Assess virological outcomes among HIV-1 infected children and adolescents receiving ART according to the national guidelines in Togo 6

Cross sectional study june - september 2014 HIV-1 infected patients aged years on ART>12 months were consecutively enrolled Collection K3-EDTA whole blood DBS confection - DBS Whatman Storage -80°C Centrifugation -Plasma aliquoted and stored -20°C -Viral Load testing m2000 rt Abbott in reference lab (Lomé / Togo) 7

- Epidemiological data, demographic information and ART history collected during sampling with a standardized questionnaire from medical records - DBS samples of Plasma samples with Viral Load testing ≥ 1000 copies /ml (WHO criteria for Virological failure sent to IRD Montpellier (France) : Genotypic drug resistance testing : protocol ANRS Pol gene region : Protease and Reverse Transcriptase Interpretation of relevant Drug Resistance Mutations : ANRS algorithm version 24 ( 8

286 HIV-1 infected pediatrics patients were recruited - median age : 10 years IQR [ 8-13 years] female 50.7% Children (2-9 years) n= 116 (40.6%) Adolescents (10-19 years) n=170 (59.4%) - cART at sampling time AZT+3TC+NVP n = 231 (80.8%) ABC /TDF+3TC+ NVP/EFV) n= 27 (9.4%) PI-based regimen n=28 (9.8%) - median duration of ART : 48 months IQR [28-68 months] Lomé commune n=192 n=9 n=15 Kara n=70 9

182(63.3%) VL> 40 copies/ml 147 (51.4%) VF 126 Genotyped Duration of ART 10

Prevalence of Drug resistant strains:94.4% prevalent NRTI mutations M184 V/I : 91.7% T215Y/F : 42.1% Prevalent NNRTI mutations Y181C: 40.5% K103N: 38.9% 11

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86.5% No effective ART or 1 effective drug in current cART 13

Cross resistance 14

-Half of this paediatric cohort on ART > 12 months was at VF due to high prevalence of NRTI and NNRTI resistance mutations -Limitations to apply WHO guidelines with 2 NRTI for second line ART in children. -Monitoring lifelong ART in children in resource-limited countries can have dramatic long-term outcomes Needs: access to routine viral load monitoring use of more potent PI- based regimens adapted formulations for the different age classes 15

16 - FSS /UL MOH Togo Lab Biolim team : Pr M. David Pr AY Dagnra UMI 233 team : Pr E. Delaporte Dr M. Peeters Dr N. Vidal Dr A. Ayouba Health care centres for PLHIV: Lomé, Tsévié, Kpalimé, Atakpamé, Kara, bafilo, Bassar