%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Salou, M.
%A Butel, Christelle
%A Comlan, A. S.
%A Konou, A. A.
%A Tegueni, K.
%A Ehlan, A.
%A Lack, F.
%A Dossim, S.
%A Ayouba, Ahidjo
%A Delaporte, E.
%A Dagnra, A. Y.
%A Peeters, Martine
%T Challenges of scale-up to dolutegravir-based regimens in sub-Saharan Africa
%D 2020
%L PAR00020654
%G ENG
%J AIDS
%@ 0269-9370
%K Africa ; dolutegravir ; drug resistance ; HIV ; Togo
%K TOGO ; AFRIQUE SUBSAHARIENNE
%M ISI:000524576600014
%N 5
%P 783-787
%R 10.1097/qad.0000000000002470
%U https://www.documentation.ird.fr/hor/PAR00020654
%V 34
%W Horizon (IRD)
%X Objective: Evaluate 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 Togo. Design: Patients on ART attending health facilities for routine follow-up visits and for whom HIV viral load test was performed were consecutively included. Methods: Protease, 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. Results: Among 1681 patients, 320 (19.04%) had viral load more than 1000 copies/ml and 200 were tested for drug resistance mutations. Reverse transcriptase gene was successfully sequenced for 181/200 (90.5%) patients; 140/181 (77.4%) were resistant to NRTIs and non-NRTIs, 4/181 (2.2%) to NRTIs only and 18/181 (9.9%) to non-NRTIs only. Many viral strains accumulated mutations predicting resistance to NRTIs 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. Conclusion: Overall, our results predict that, at the scale of sub-Saharan Africa a significant proportion of patients could be on functional monotherapy. To 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. Studies designed to quantify the implications of use of suboptimal DTG-based regimens are also needed.
%$ 052 ; 050