Extraordinary Heterogeneity of Virological Outcomes in Patients Receiving Highly Antiretroviral Therapy and Monitored With the World Health Organization Public Health Approach in Sub-Saharan Africa and Southeast Asia
In: Clinical Infectious Diseases, Jg. 58 (2013-09-27), S. 99-109
Online
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Zugriff:
Background. The limited access to virological monitoring in developing countries is a major weakness of the current antiretroviral treatment (ART) strategy in these settings. We conducted a large cross-sectional study in Burkina Faso, Cameroon, Cote d'Ivoire, Senegal, Togo, Thailand, and Vietnam to assess virological failure and drug resistance mutations (DRMs) after 12 or 24 months of ART. Methods. Between 2009 and 2011, we recruited adults attending ART centers 10-14 months (the M12 group) or 22-26 months (M24 group) after initiating ART. Demographic and clinical data were collected on site, and viral load was measured. Samples with a viral load of >= 1000 copies/mL, considered as the failure threshold, were geno-typed for drug resistance assessment. Results. Overall, 3935 patients were recruited (2060 at M12 and 1875 at M24). Median ages varied from 32 to 42 years. Median CD4(+) T-cell counts at ART initiation were low (99-172 cells/mu L). The main ART regimens included stavudine/zidovudine plus lamivudine plus nevirapine/efavirenz. Overall, virological failure frequency was 11.1% for M12 patients and 12.4% for M24 patients, and 71.0% to 86.1% of these patients, respectively, had drug-resistant virus. Across sites, virological failure varied from 2.9% to 20.6% in M12 patients and from 3.7% to 26.0% in M24 patients. Predominant DRMs were associated with ART regimens, but virus in several patients accumulated DRMs to drugs not received, such as abacavir, didanosine, tenofovir, etravirine, and rilpivirine. Conclusions. Our findings show heterogeneous virological failure and illustrate that, in addition to routine access to viral load, good management of ART programs is even more critical to improve treatment outcomes in resource-limited countries.
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Extraordinary Heterogeneity of Virological Outcomes in Patients Receiving Highly Antiretroviral Therapy and Monitored With the World Health Organization Public Health Approach in Sub-Saharan Africa and Southeast Asia
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Autor/in / Beteiligte Person: | Avelin F, Aghokeng ; Marjorie, Monleau ; Sabrina, Eymard-Duvernay ; Anoumou, Dagnra ; Dramane, Kania ; Nicole, Ngo-Giang-Huong ; Thomas D, Toni ; Coumba, Touré-Kane ; Lien X T, Truong ; Eric, Delaporte ; Marie-Laure, Chaix ; Martine, Peeters ; Ahidjo, Ayouba ; Bui, The Thu Phuong ; VIH/SIDA et maladies associées ; Université Montpellier 1 ( UM1 ) ; Nutrition Recherche Unit 106 ; Institut de Recherche pour le Développement ( IRD ) ; Épidémiologie clinique, santé mère-enfant et VIH en Asie du Sud-Est ( IRD_PHPT ) ; Harvard University [Cambridge]-Chiang Mai university (Thaïlande) ; PAC-CI, Programme ; ANRS ; Chimie Organique et Bioorganique : Reactivité et Analyse ( COBRA ) ; Centre National de la Recherche Scientifique ( CNRS ) -Institut de Chimie Organique Fine ( IRCOF ) ; Université de Rouen Normandie ( UNIROUEN ) ; Normandie Université ( NU ) -Normandie Université ( NU ) -Institut national des sciences appliquées Rouen Normandie ( INSA Rouen Normandie ) ; Normandie Université ( NU ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Rouen Normandie ( UNIROUEN ) ; Normandie Université ( NU ) -Centre National de la Recherche Scientifique ( CNRS ) ; Laboratoire de Virologie [CHU Necker] ; Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP] ; Recherches Translationnelles sur le VIH et les maladies infectieuses ( TransVIHMI ) ; Université de Montpellier ( UM ) -Universtié Yaoundé 1 [Cameroun]-Université Cheikh Anta Diop ( UCAD ) -Université Montpellier 1 ( UM1 ) -Institut de Recherche pour le Développement ( IRD ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) ; Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI) ; Université Montpellier 1 (UM1)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM) ; Épidémiologie clinique, santé mère-enfant et VIH en Asie du Sud-Est (IRD_PHPT) ; Harvard University [Cambridge]-Chiang Mai University (CMU) ; ANRS France Recherche Nord & sud Sida-hiv hépatites ; Institut de Recherche pour le Développement (IRD) ; CHU Necker - Enfants Malades [AP-HP] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP) |
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Zeitschrift: | Clinical Infectious Diseases, Jg. 58 (2013-09-27), S. 99-109 |
Veröffentlichung: | Oxford University Press (OUP), 2013 |
Medientyp: | unknown |
ISSN: | 1537-6591 (print) ; 1058-4838 (print) |
DOI: | 10.1093/cid/cit627 |
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