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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
High level of HIV-1 resistance in patients failing long-term first-line antiretroviral therapy in Mali
Journal of Antimicrobial Chemotherapy, Volume 69, No. 9, Article dku153, Year 2014
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Description
Objectives: In resource-limited settings, few data are available on virological failure after long-term first-line antiretroviral therapy. This study characterized the genotypic resistance patterns at the time of failure after at least 36 months of a first-line regimen in Mali, West Africa. Methods: Plasma samples from 84 patients who were receiving first-line antiretroviral treatment and with an HIV-1 RNA viral load (VL)>1000 copies/mL were analysed. Genotypic resistance testing was performed and HIV-1 drug resistance was interpreted according to the latest version of the National Agency for HIV and Hepatitis Research algorithm. Results: At the time of resistance testing, patients had been treated for a median of 60 months (IQR 36- 132 months) and had a median CD4 cell count of 292 cells/mm3 (IQR 6-1319 cells/mm3), a median HIV-1 RNA level of 28266 copies/mL (IQR 1000-2938495 copies/mL) and a median genotypic susceptibility score of 1 (IQR 1-4). The prevalence of nucleoside reverse transcriptase inhibitor (NRTI) and non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance mutations was 78% and 82%, respectively. Viruseswere resistant to at least one drug in 92% of cases. Although etravirine and rilpivirine were not used in the first-line regimens, viruses were resistant to etravirine in 34% of cases and to rilpivirine in 49% of cases. The treatment duration, median number of NRTI and NNRTI mutations and some reverse transcriptase mutations (T215Y/F/N, L210W, L74I, M41L and H221Y) were associated with the VL at virological failure. Conclusions: This study demonstrated a high level of resistance to NRTIs and NNRTIs, compromising secondgeneration NNRTIs, for patients who stayed on long-term first-line regimens. It is crucial to expand the accessibility of virological testing in resource-limited settings to limit the expansion of resistance and preserve second-line treatment efficacy. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
Authors & Co-Authors
Fofana, Djeneba Bocar
France, Paris
Sorbonne Université
France, Paris
Institut Pierre Louis D'epidémiologie et de Santé Publique
France, Paris
Laboratoire de Virologie
Soulié, Cathia
France, Paris
Sorbonne Université
France, Paris
Institut Pierre Louis D'epidémiologie et de Santé Publique
France, Paris
Laboratoire de Virologie
Baldeé, A.
Mali, Bamako
Université Des Sciences Des Techniques et Des Technologies
Lambert-Niclot, Sidonie
France, Paris
Sorbonne Université
France, Paris
Institut Pierre Louis D'epidémiologie et de Santé Publique
France, Paris
Laboratoire de Virologie
Sylla, Mohamed
Mali, Bamako
Université Des Sciences Des Techniques et Des Technologies
Aït-Arkoub, Zaïna
France, Paris
Sorbonne Université
France, Paris
Institut Pierre Louis D'epidémiologie et de Santé Publique
France, Paris
Laboratoire de Virologie
Diallo, Fodié B.
Mali, Bamako
Cesac
Sangaré, B.
Mali, Bamako
Usac Commune I
Cissé, Mamadou C.
Mali, Bamako
Cesac
Maïga, Issouf Alassane
Mali, Bamako
Esther
Fourati, Slim
France, Paris
Sorbonne Université
France, Paris
Institut Pierre Louis D'epidémiologie et de Santé Publique
France, Paris
Laboratoire de Virologie
Koita, Ousmane A.
Mali, Bamako
Université Des Sciences Des Techniques et Des Technologies
Calvez, Vincent
France, Paris
Sorbonne Université
France, Paris
Institut Pierre Louis D'epidémiologie et de Santé Publique
France, Paris
Laboratoire de Virologie
Marcelin, Anne Geneviève
France, Paris
Sorbonne Université
France, Paris
Institut Pierre Louis D'epidémiologie et de Santé Publique
France, Paris
Laboratoire de Virologie
Maïga, Almoustapha Issiaka
Mali, Bamako
Université Des Sciences Des Techniques et Des Technologies
Statistics
Citations: 23
Authors: 15
Affiliations: 7
Identifiers
Doi:
10.1093/jac/dku153
ISSN:
03057453
e-ISSN:
14602091
Research Areas
Cancer
Infectious Diseases
Study Design
Cross Sectional Study
Study Locations
Multi-countries
Mali