@article{fdi:010068794,
  title = {{H}igh viral load and multidrug resistance due to late switch to second-line regimens could be a major obstacle to reach the 90-90-90 {UNAIDS} objectives in {S}ub-{S}aharan {A}frica : {S}hort communication},
  author = {{G}uichet, {E}milande and {A}ghokeng {F}obang, {A}velin and {S}errano, {L}. and {B}ado, {G}. and {T}oure-{K}ane, {C}. and {E}ymard-{D}uvernay, {S}abrina and {V}illabona-{A}renas, {C}. {J}. and {D}elaporte, {E}ric and {C}iaffi, {L}. and {P}eeters, {M}artine},
  editor = {},
  language = {{ENG}},
  abstract = {{I}n the context of lifelong antiretroviral treatment ({ART}) as early as possible and to end the {HIV}/{AIDS} epidemic as a public health treat by 2030, it is important to evaluate the potential risk of transmission of {HIV}-1 drug resistance ({HIVDR}) in resource-limited countries ({RLC}s). {S}ince {HIV} transmission is driven by {HIV}-1 {RNA} viral load ({VL}), we studied the association between plasma {VL} and {HIVDR} profiles in 451 adults failing first-line {ART} from the 2{LADY}-{ANRS}12169/{EDCTP} trial in {B}urkina {F}aso, {C}ameroon, and {S}enegal. {M}edian duration on first-line {ART} was 49 months ({IQR}: 33-69) and 91% patients were asymptomatic. {G}enotypic drug resistance testing was successful for 446 patients and 98.7% of them were resistant to at least one of the first-line drugs; 40.6% and 55.8% were resistant to two or three drugs of their ongoing first-line {ART}, respectively. {T}he median {VL} was higher in patients with {HIVDR} to all ongoing first-line drugs than in those still susceptible to at least one drug; 4.7 log(10) copies/ml ({IQR}: 4.3-5.2) versus 4.2 log(10) copies/ml ({IQR}: 3.7-4.7), respectively (p<.001). {T}he proportion of patients with {HIVDR} to all ongoing first-line drugs was highest (77.9% [95/122]) in patients with {VL} >5.0 log(10) copies/ml. {H}igh rates of cross-resistance to other nucleoside reverse-transcriptase inhibitors were observed and were also highest in patients with high {VL}. {W}ithout improvement of patient monitoring to avoid late switch to second-line regimens, a potential new epidemic caused by {HIVDR} strains could emerge in sub-{S}aharan {A}frica and compromise all efforts to reach 90-90-90 {UNAIDS} objective by 2020.},
  keywords = {{HIV} ; viral load ; drug resistance ; antiretroviral therapy ; {A}frica ; {BURKINA} {FASO} ; {CAMEROUN} ; {SENEGAL} ; {AFRIQUE} {SUBSAHARIENNE}},
  booktitle = {},
  journal = {{A}ids {R}esearch and {H}uman {R}etroviruses},
  volume = {32},
  numero = {12},
  pages = {1159--1162},
  ISSN = {0889-2229},
  year = {2016},
  DOI = {10.1089/aid.2016.0010},
  URL = {https://www.documentation.ird.fr/hor/fdi:010068794},
}