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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Level of viral load and antiretroviral resistance after 6 months of non-nucleoside reverse transcriptase inhibitor first-line treatment in HIV-1-infected children in Mali
Journal of Antimicrobial Chemotherapy, Volume 65, No. 1, Year 2009
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Description
Objectives: To evaluate the virological response and to describe the resistance profiles in the case of failure after 6 months of first-line highly active antiretroviral therapy (HAART) in HIV-1-infected children living in resource-limited settings. Patients and methods: Ninety-seven HIV-1-infected children who started two nucleoside reverse transcriptase inhibitors (NRTIs) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) (mainly zidovudine/lamivudine/nevirapine) in Mali were prospectively studied. Virological failure (VF) was defined as loss to follow-up, death or HIV-1 RNA viral load (VL) of >400 copies/mL at 6 months. When VL was >50 copies/mL, a genotypic resistance test was performed. Results: Among the 97 children, median age at antiretroviral initiation was 31 months and the majority were in WHO clinical (77.3%) and immunological (70.1%) stage III or IV. At month 6, 44% of children had VL >400 copies/mL (61% VF). Among the children with detectable VL, 30/37 genotypic resistance tests were available, 8 with wild-type viruses and 22 with resistance mutations (73%): 19 M184V/I, 21 NNRTI mutations and only 3 thymidine analogue mutations (TAMs) (K70R, D67N and L210W in three distinct viruses). At failure, 6/8 children with wild-type viruses had a VL of <1000 copies/mL whereas 21/22 with resistant viruses had a VL of >1000 copies/mL. Conclusions: Under NNRTI-based regimens, early detection of VF could allow the reinforcement of adherence when VL was <1000 copies/mL, because in most of these cases no resistance mutations were detected, or a change to a protease inhibitor-based regimen if VL was >1000 copies/mL. The low frequency of TAMs suggests that most NRTIs can be used in a second-line regimen after early failure. © The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.
Authors & Co-Authors
Germanaud, David
Mali, Bamako
Solthis
Derache, Anne
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Madec, Yoann
France, Paris
Institut Pasteur, Paris
Toure, Safiatou
Mali, Bamako
Hopital Gabriel Toure
Dicko-Traoré, Fatoumata B.
Mali, Bamako
Hopital Gabriel Toure
Coulibaly, Hadizatou
Mali, Bamako
Hopital Gabriel Toure
Traoré, Malick
Mali, Bamako
Institut National de Recherche en Sante Publique Mali
Sylla, Mariam Moustapha
Mali, Bamako
Hopital Gabriel Toure
Calvez, Vincent
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Marcelin, Anne Geneviève
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Statistics
Citations: 62
Authors: 10
Affiliations: 5
Identifiers
Doi:
10.1093/jac/dkp412
ISSN:
03057453
e-ISSN:
14602091
Research Areas
Cancer
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Study Locations
Mali