Journal ArticleDOI
Resistance to antiretroviral drugs in treated and drug-naive patients in the Democratic Republic of Congo.
Jérémie Muwonga,Samuel Edidi,Christelle Butel,Nicole Vidal,Marjorie Monleau,Augustin Okenge,Jean Lambert Mandjo,Henry Mukumbi,Jean Jacques Muyembe,Ferdinand Mbayo,Donatien Kayembe Nzongola,Eric Delaporte,François Boillot,Martine Peeters +13 more
TLDR
The accumulation of drug resistance mutations with time on ART needs further attention, and surveillance should be reinforced in ART programs in sub-Saharan Africa.Abstract:
BACKGROUND We studied virological outcome and drug resistance in patients on antiretroviral therapy (ART) in health care centers in the Democratic Republic of Congo and looked for the presence of drug resistance in antiretroviral-naive patients attending the same clinics. METHODS In 2008, we conducted a cross-sectional survey among patients on ART for ≥ 12 months in 4 major cities [Kinshasa (n = 289), Matadi (n = 198), Lubumbashi (n = 77), and Mbuji-Mayi (n = 103)]. Genotypic drug resistance tests were done with an in-house assay on samples with viral load >1000 copies/mL. ART-naive patients (n = 283) were also consecutively enrolled in the same clinics. RESULTS Of the 667 patients on ART, >98% received Lamivudine + Stavudine/azidothymidine + Nevirapine/Efavirenz as first-line regimen and 74.4% were women. Median time on ART was 25 months [interquartile ratio (IQR), 19-32] in Kinshasa, 26 months (IQR, 19-32) in Matadi, 27 months (IQR, 19-44) in Lubumbashi, and 19 months (IQR, 16-24) in Mbuji-Mayi. A total of 97 patients (14.6%) had viral load >1000 copies/mL, and among the 93 successfully sequenced samples, 78 (83.9%) were resistant to at least 1 drug of their ART regimen: 68 harbored resistance mutations to nucleoside reverse transcriptase inhibitor (NRTI) and nonnucleoside reverse transcriptase inhibitor (NNRTI), 2 to NRTI only, 7 to NNRTI only, and 1 to NRTI + NNRTI + protease inhibitor. The majority of patients, 70/78 (89.7%), were resistant to at least 2 of the 3 drugs from their treatment. The use of next-generation NNRTI, etravirine was already compromised for 19.2% (15/78) of the patients and 7 patients had the K65R mutation compromising the use of tenofovir in second-line regimens. The proportion of antiretroviral-resistant patients increased over time from 8.4% to 18.6% for patients on ART for 12-23 months or >35 months (P = 0.013), respectively. Virological failure and rates of drug resistance were significantly higher among men than women, 19.9% versus 8.8%, respectively (P = 0.0001). Among the 253 recently diagnosed patients, 20 (7.9%) harbored resistance mutations. CONCLUSIONS The accumulation of drug resistance mutations with time on ART needs further attention, and surveillance should be reinforced in ART programs in sub-Saharan Africa.read more
Citations
More filters
Journal Article
Update on HIV-1 diversity in Africa: a decade in review.
TL;DR: The regional distributions of individual subtypes and recombinants are broadly stable, although unique/circulating recombinant forms may play an increasing role in the HIV pandemic.
Journal ArticleDOI
Rates of emergence of HIV drug resistance in resource-limited settings: a systematic review.
TL;DR: The emergence of drug resistance following access to ART in resource-limited settings resembles what was seen inresource-rich countries and highlights the need for virological monitoring for drug failure, drug resistance testing and alternative drug regimens that have proven beneficial in these resource-rich settings.
Journal ArticleDOI
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
Avelin F. Aghokeng,Marjorie Monleau,Sabrina Eymard-Duvernay,Anoumou Dagnra,Dramane Kania,Nicole Ngo-Giang-Huong,Thomas d. 'Aquin Toni,Coumba Toure-Kane,Lien X. T. Truong,Eric Delaporte,Marie-Laure Chaix,Martine Peeters,Ahidjo Ayouba +12 more
TL;DR: The 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.
Journal ArticleDOI
Modeling dynamic interactions between pre-exposure prophylaxis interventions & treatment programs: predicting HIV transmission & resistance
Virginie Supervie,Virginie Supervie,Meagan Barrett,James O. Kahn,Godfrey Musuka,Themba Moeti,Lesego Busang,Sally Blower +7 more
TL;DR: This work uses response hypersurface modeling to predict the effect of PrEP on decreasing transmission as a function of effectiveness, adherence and coverage, and predicts PrEP will increase need for second-line therapies (SLT) for treatment-naïve individuals, but could significantly decrease need for SLT fortreatment-experienced individuals.
Journal ArticleDOI
Virological failure rates and HIV-1 drug resistance patterns in patients on first-line antiretroviral treatment in semirural and rural Gabon
Florian Liegeois,Caroline Vella,Sabrina Eymard-Duvernay,Jeanne Sica,Laurent Makosso,Augustin Mouinga-Ondémé,Arnaud Delis Mongo,Vanina Boué,Christelle Butel,Martine Peeters,Jean-Paul Gonzalez,Eric Delaporte,François Rouet +12 more
TL;DR: As antiretroviral treatment (ART) continues to expand in resource‐limited countries, the emergence of HIV drug resistance mutations (DRMs) is challenging in these settings.
References
More filters
Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach. 2006 revision.
TL;DR: These guidelines are primarily intended for use by national and regional HIV programme managers managers of nongovernmental organizations delivering HIV care services and other policy-makers who are involved in the scaling up of comprehensive HIV care and ART in resource-limited countries.
Journal ArticleDOI
Drug Resistance Mutations for Surveillance of Transmitted HIV-1 Drug-Resistance: 2009 Update
Diane E Bennett,Ricardo Jorge Camacho,Dan Otelea,Daniel R. Kuritzkes,Hervé Fleury,Mark Kiuchi,Walid Heneine,Rami Kantor,Michael R. Jordan,Jonathan M. Schapiro,Anne-Mieke Vandamme,Paul Sandstrom,Charles A. Boucher,Charles A. Boucher,David A. M. C. van de Vijver,Soo-Yon Rhee,Tommy F. Liu,Deenan Pillay,Robert W. Shafer +18 more
TL;DR: This paper follows the same procedures described previously to develop an updated list of SDRMs that are likely to be useful for ongoing and future studies of transmitted drug resistance and concludes that the updated SDRM list has 93 mutations.
Journal ArticleDOI
The WHO public-health approach to antiretroviral treatment against HIV in resource-limited settings
Charles F. Gilks,Siobhan Crowley,Rene Ekpini,Sandy Gove,Jos Perriens,Yves Souteyrand,Don Sutherland,Marco Vitoria,Teguest Guerma,Kevin M. De Cock +9 more
TL;DR: A public-health approach to antiretroviral therapy (ART) to enable scaling-up access to treatment for HIV-positive people in developing countries, recognising that the western model of specialist physician management and advanced laboratory monitoring is not feasible in resource-poor settings.
Journal ArticleDOI
Scaling up of highly active antiretroviral therapy in a rural district of Malawi: an effectiveness assessment.
Laurent Ferradini,Arnaud Jeannin,Loretxu Pinoges,Jacques Izopet,Didakus Odhiambo,Limangeni Mankhambo,Gloria Karungi,Elisabeth Szumilin,Serge Balandine,Gaëlle Fedida,M. Patrizia Carrieri,Bruno Spire,Nathan Ford,Jean-Michel Tassie,Philippe J Guerin,Christopher Brasher +15 more
TL;DR: These data show that large numbers of people can rapidly benefit from antiretroviral therapy in rural resource-poor settings and strongly supports the implementation of such large-scale simplified programmes in Africa.
Journal ArticleDOI
Prevalence of Drug-Resistant HIV-1 Variants in Untreated Individuals in Europe: Implications for Clinical Management
Annemarie M. J. Wensing,David A. M. C. van de Vijver,Gioacchino Angarano,Birgitta Åsjö,Claudia Balotta,Enzo Boeri,Ricardo Jorge Camacho,Maire-Laure Chaix,Dominique Costagliola,Andrea De Luca,Inge Derdelinckx,Zehava Grossman,Osamah Hamouda,Angelos Hatzakis,Robert Hemmer,Andy I. M. Hoepelman,Andrzej Horban,Klaus Korn,Claudia Kücherer,Thomas Leitner,Clive Loveday,E MacRae,I Maljkovic,Carmen de Mendoza,Laurence Meyer,Claus J. Nielsen,Eline L. M. Op de Coul,Vidar Ormaasen,D Paraskevis,Luc Perrin,Elisabeth Puchhammer-Stöckl,Lidia Ruiz,Mika Salminen,Jean-Claude Schmit,François Schneider,Rob Schuurman,Vincent Soriano,G Stanczak,Maja Stanojevic,Anne-Mieke Vandamme,Kristel Van Laethem,Michela Violin,Karin Wilbe,Sabine Yerly,Maurizio Zazzi,Charles A. Boucher +45 more
TL;DR: In this paper, the authors determined the baseline rate of drug resistance in 2208 therapy-naive patients recently and chronically infected with HIV-1 from 19 European countries during 1996-2002.