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 language | English |
|---|---|
| Pages (from-to) | 339-347 |
| Number of pages | 9 |
| Journal | Antiviral Therapy |
| Volume | 14 |
| Issue number | 3 |
| Publication status | Published - 2009 |
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ASJC Scopus subject areas
- Pharmacology
- Pharmacology (medical)
- Infectious Diseases
Cite this
Resistance profiles after different periods of exposure to a first-line antiretroviral regimen in a Cameroonian cohort of HIV type-1-1infected patients. / Soria, Alessandro; Porten, Klaudia; Fampou-Toundji, Jean Calvin; Galli, Laura; Mougnutou, Rose; Buard, Vincent; Kfutwah, Anfumbom; Vessière, Aurelia; Roussert, Dominique; Teck, Roger; Calmy, Alexandra; Ciaffi, Laura; Lazzarin, Andriano; Gianotti, Nicola.
In: Antiviral Therapy, Vol. 14, No. 3, 2009, p. 339-347.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Resistance profiles after different periods of exposure to a first-line antiretroviral regimen in a Cameroonian cohort of HIV type-1-1infected patients
AU - Soria, Alessandro
AU - Porten, Klaudia
AU - Fampou-Toundji, Jean Calvin
AU - Galli, Laura
AU - Mougnutou, Rose
AU - Buard, Vincent
AU - Kfutwah, Anfumbom
AU - Vessière, Aurelia
AU - Roussert, Dominique
AU - Teck, Roger
AU - Calmy, Alexandra
AU - Ciaffi, Laura
AU - Lazzarin, Andriano
AU - Gianotti, Nicola
PY - 2009
Y1 - 2009
N2 - 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.
AB - 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.
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M3 - Article
VL - 14
SP - 339
EP - 347
JO - Antiviral Therapy
JF - Antiviral Therapy
SN - 1359-6535
IS - 3
ER -