%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Guichet, Emilande
%A Aghokeng Fobang, Avelin
%A Serrano, L.
%A Bado, G.
%A Toure-Kane, C.
%A Eymard-Duvernay, Sabrina
%A Villabona-Arenas, C. J.
%A Delaporte, Eric
%A Ciaffi, L.
%A Peeters, Martine
%T High 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 Sub-Saharan Africa : Short communication
%D 2016
%L fdi:010068794
%G ENG
%J Aids Research and Human Retroviruses
%@ 0889-2229
%K HIV ; viral load ; drug resistance ; antiretroviral therapy ; Africa
%K BURKINA FASO ; CAMEROUN ; SENEGAL ; AFRIQUE SUBSAHARIENNE
%M ISI:000390592600001
%N 12
%P 1159-1162
%R 10.1089/aid.2016.0010
%U https://www.documentation.ird.fr/hor/fdi:010068794
%> https://www.documentation.ird.fr/intranet/publi/2017/01/010068794.pdf
%V 32
%W Horizon (IRD)
%X In 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 (RLCs). Since 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 2LADY-ANRS12169/EDCTP trial in Burkina Faso, Cameroon, and Senegal. Median duration on first-line ART was 49 months (IQR: 33-69) and 91% patients were asymptomatic. Genotypic 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. The 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). The 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. High rates of cross-resistance to other nucleoside reverse-transcriptase inhibitors were observed and were also highest in patients with high VL. Without improvement of patient monitoring to avoid late switch to second-line regimens, a potential new epidemic caused by HIVDR strains could emerge in sub-Saharan Africa and compromise all efforts to reach 90-90-90 UNAIDS objective by 2020.
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