Resistance profiles after different periods of exposure to a first-line antiretroviral regimen in a Cameroonian cohort of HIV type-1-1infected patients

Alessandro Soria, Klaudia Porten, Jean Calvin Fampou-Toundji, Laura Galli, Rose Mougnutou, Vincent Buard, Anfumbom Kfutwah, Aurelia Vessière, Dominique Roussert, Roger Teck, Alexandra Calmy, Laura Ciaffi, Andriano Lazzarin, Nicola Gianotti

Research output: Contribution to journalArticle

Abstract

Background: The lack of HIV type-1 (HIV-1) viral load (VL) monitoring in resource-limited settings might favour the accumulation of resistance mutations and thus hamper second-line treatment efficacy. We investigated the factors associated with resistance after the initiation of antiretroviral therapy (ART) in the absence of virological monitoring. Methods: Cross-sectional VL sampling of HIV-1-infected patients receiving first-line ART (nevirapine or efavirenz plus stavudine or zidovudine plus lamivudine) was carried out; those with a detectable VL were genotyped. Results: Of the 573 patients undergoing VL sampling, 84 were genotyped. The mean number of nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) mutations increased with the duration of ART exposure (P=0.02). Multivariable analysis showed that patients with a CD4+ T-cell count ≤50 cells/mm3 at ART initiation (baseline) had a higher mean number of both NRTI and non-NRTI (NNRTI) mutations than those with a baseline CD4+ T-cell count >50 cells/mm3 (2.10 versus 0.56; P+ T-cell count ≤50 cells/mm3 predicted ≥1 NRTI mutation (adjusted odds ratio [AOR] 7.49, 95% confidence interval [Cl] 2.20-32.14), ≥1 NNRTI mutation (AOR 4.25, 95% Cl 1.36-15.48), ≥1 thymidine analogue mutation (AOR 8.45, 95% Cl 2.16-40.16) and resistance to didanosine (AOR 6.36, 95% Cl 1.49-32.29) and etravirine (AOR 4.72, 95% Cl 1.53-15.70). Conclusions: Without VL monitoring, the risk of drug resistance increases with the duration of ART and is associated with lower CD4+ T-cell counts at ART initiation. These data might help define strategies to preserve second-line treatment options in resource-limited settings.

Original languageEnglish
Pages (from-to)339-347
Number of pages9
JournalAntiviral Therapy
Volume14
Issue number3
Publication statusPublished - 2009

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

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    Soria, A., Porten, K., Fampou-Toundji, J. C., Galli, L., Mougnutou, R., Buard, V., Kfutwah, A., Vessière, A., Roussert, D., Teck, R., Calmy, A., Ciaffi, L., Lazzarin, A., & Gianotti, N. (2009). Resistance profiles after different periods of exposure to a first-line antiretroviral regimen in a Cameroonian cohort of HIV type-1-1infected patients. Antiviral Therapy, 14(3), 339-347.