@article{PAR00020654,
  title = {{C}hallenges of scale-up to dolutegravir-based regimens in sub-{S}aharan {A}frica},
  author = {{S}alou, {M}. and {B}utel, {C}hristelle and {C}omlan, {A}. {S}. and {K}onou, {A}. {A}. and {T}egueni, {K}. and {E}hlan, {A}. and {L}ack, {F}. and {D}ossim, {S}. and {A}youba, {A}hidjo and {D}elaporte, {E}. and {D}agnra, {A}. {Y}. and {P}eeters, {M}artine},
  editor = {},
  language = {{ENG}},
  abstract = {{O}bjective: {E}valuate the potential effectiveness of the implementation of dolutegravir ({DTG})-based regimens in patients on failing current antiretroviral treatment ({ART}) given the high levels of nucleoside reverse transcriptase inhibitor ({NRTI}) resistance in {T}ogo. {D}esign: {P}atients on {ART} attending health facilities for routine follow-up visits and for whom {HIV} viral load test was performed were consecutively included. {M}ethods: {P}rotease, reverse transcriptase and integrase fragments were sequenced and analyzed for presence of drug resistance mutations for patients with viral load more than 1000 copies/ml. {R}esults: {A}mong 1681 patients, 320 (19.04%) had viral load more than 1000 copies/ml and 200 were tested for drug resistance mutations. {R}everse transcriptase gene was successfully sequenced for 181/200 (90.5%) patients; 140/181 (77.4%) were resistant to {NRTI}s and non-{NRTI}s, 4/181 (2.2%) to {NRTI}s only and 18/181 (9.9%) to non-{NRTI}s only. {M}any viral strains accumulated mutations predicting resistance to {NRTI}s recommended in first and second-line {DTG}-based {ART} regimens. {ART} switch to a {DTG}-based regimen after viral load testing (viral load >1000 copies/ml) or blind switch without prior viral load testing to a new {DTG}-based first line, estimated 31% and 47.6% of patients to be potentially on functional {DTG} monotherapy respectively. {C}onclusion: {O}verall, our results predict that, at the scale of sub-{S}aharan {A}frica a significant proportion of patients could be on functional monotherapy. {T}o achieve the third 90 of {UNAIDS} objectives, implementation of {DTG}-based regimens should be accompanied with an accelerated scaling up of access to viral load. {S}tudies designed to quantify the implications of use of suboptimal {DTG}-based regimens are also needed.},
  keywords = {{A}frica ; dolutegravir ; drug resistance ; {HIV} ; {T}ogo ; {TOGO} ; {AFRIQUE} {SUBSAHARIENNE}},
  booktitle = {},
  journal = {{AIDS}},
  volume = {34},
  numero = {5},
  pages = {783--787},
  ISSN = {0269-9370},
  year = {2020},
  DOI = {10.1097/qad.0000000000002470},
  URL = {https://www.documentation.ird.fr/hor/{PAR}00020654},
}