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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
HIV type 1 drug resistance in adults receiving highly active antiretroviral therapy in abidjan, côte d'ivoire
AIDS Research and Human Retroviruses, Volume 25, No. 5, Year 2009
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Description
As antiretroviral therapy continues to scale-up in developing countries, there is concern that high levels of HIV drug resistance to antiretroviral drugs will occur. Here we describe rates of emergence of HIV-1 drug resistance and factors associated with their occurrence among adults who received antiretroviral therapy (ART) for >1 year through the Côte d'Ivoire national drug access program from 1998 to 2003. To detect genotypic drug resistance, we sequenced all 1- and 2-year specimens with detectable HIV RNA viral load. To assess factors associated with emerging drug resistance, we used log normal regression with interval censoring, including covariates in the model for self-reported drug adherence, CD4 cell count, and HIV viral load at therapy initiation, and observed changes in these measures, type of prescribed ART drugs, diagnoses of opportunistic illness, and demographic characteristics. An estimated 14.2% [95% confidence limits (CL) 11.7, 16.9] and 26.6% (95% CL 22.7, 30.8) of patients developed primary drug-resistant mutations within 1 year and 2 years after initiation of therapy, respectively. Factors associated with drug resistance included drug nonadherence, partial or lack of viral suppression, higher viral load or lower CD4 at initiation of therapy, and initiation of ART with what is now considered substandard dual combination therapy. Our results demonstrate the need to strengthen adherence and continuity in treatment programs in order to avoid interruption of ART drugs. Treatment programs should pay attention to indicators of emerging drug resistance: incomplete or lesser decreases in viral load or increases in CD4 cell counts following initiation of therapy, and the occurrence of AIDS opportunistic illnesses. © 2009 Mary Ann Liebert, Inc.
Authors & Co-Authors
Hanson, Debra L.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Adjé-Touré, Christiane A.
Cote D'ivoire, Abidjan
Project Retro-ci Abidjan
Talla-Nzussouo, Ndahwouh
Cote D'ivoire, Abidjan
Project Retro-ci Abidjan
Eby, Pascal
Cote D'ivoire, Abidjan
Project Retro-ci Abidjan
Borget, Marie Yolande
Cote D'ivoire, Abidjan
Project Retro-ci Abidjan
Kouadio, Léonard Ya
Cote D'ivoire, Abidjan
Project Retro-ci Abidjan
Celestin, Bilé
Cote D'ivoire, Abidjan
Project Retro-ci Abidjan
Tossou, Odette
Cote D'ivoire, Abidjan
Project Retro-ci Abidjan
Eholié, Serge Paul
Cote D'ivoire, Abidjan
Teaching Hospital
Kadio, Auguste
Cote D'ivoire, Abidjan
Teaching Hospital
Chorba, Terence L.
Cote D'ivoire, Abidjan
Project Retro-ci Abidjan
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
N’kengasong, John Nkemngong
Cote D'ivoire, Abidjan
Project Retro-ci Abidjan
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Statistics
Citations: 12
Authors: 12
Affiliations: 3
Identifiers
Doi:
10.1089/aid.2008.0273
ISSN:
08892229
Research Areas
Health System And Policy
Infectious Diseases
Study Locations
Ivory Coast