@article{fdi:010053681,
  title = {{R}esistance to antiretroviral drugs in treated and drug-naive patients in the {D}emocratic {R}epublic of {C}ongo},
  author = {{M}uwonga, {J}. and {E}didi, {S}. and {B}utel, {C}hristelle and {V}idal, {N}icole and {M}onleau, {M}arjorie and {O}kenge, {A}. and {M}andjo, {J}. {L}. and {M}ukumbi, {H}. and {M}uyembe, {J}. {J}. and {M}bayo, {F}. and {N}zongola, {D}. {K}. and {D}elaporte, {E}ric and {B}oillot, {F}. and {P}eeters, {M}artine},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {W}e studied virological outcome and drug resistance in patients on antiretroviral therapy ({ART}) in health care centers in the {D}emocratic {R}epublic of {C}ongo and looked for the presence of drug resistance in antiretroviral-naive patients attending the same clinics. {M}ethods: {I}n 2008, we conducted a cross-sectional survey among patients on {ART} for >= 12 months in 4 major cities [{K}inshasa (n = 289), {M}atadi (n = 198), {L}ubumbashi (n = 77), and {M}buji-{M}ayi (n = 103)]. {G}enotypic drug resistance tests were done with an in-house assay on samples with viral load > 1000 copies/m{L}. {ART}-naive patients (n = 283) were also consecutively enrolled in the same clinics. {R}esults: {O}f the 667 patients on {ART}, > 98% received {L}amivudine + {S}tavudine/azidothymidine + {N}evirapine/{E}favirenz as first-line regimen and 74.4% were women. {M}edian time on {ART} was 25 months [interquartile ratio ({IQR}), 19-32] in {K}inshasa, 26 months ({IQR}, 19-32) in {M}atadi, 27 months ({IQR}, 19-44) in {L}ubumbashi, and 19 months ({IQR}, 16-24) in {M}buji-{M}ayi. {A} total of 97 patients (14.6%) had viral load > 1000 copies/m{L}, 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. {T}he majority of patients, 70/78 (89.7%), were resistant to at least 2 of the 3 drugs from their treatment. {T}he use of next-generation {NNRTI}, etravirine was already compromised for 19.2% (15/78) of the patients and 7 patients had the {K}65{R} mutation compromising the use of tenofovir in second-line regimens. {T}he 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. {V}irological failure and rates of drug resistance were significantly higher among men than women, 19.9% versus 8.8%, respectively ({P} = 0.0001). {A}mong the 253 recently diagnosed patients, 20 (7.9%) harbored resistance mutations. {C}onclusions: {T}he accumulation of drug resistance mutations with time on {ART} needs further attention, and surveillance should be reinforced in {ART} programs in sub-{S}aharan {A}frica.},
  keywords = {{HIV} ; drug resistance ; {A}frica ; {D}emocratic {R}epublic of {C}ongo},
  booktitle = {},
  journal = {{J}aids.{J}ournal of {A}cquired {I}mmune {D}eficiency {S}yndromes},
  volume = {57},
  numero = {{S}uppl. 1},
  pages = {{S}27--{S}33},
  ISSN = {1525-4135},
  year = {2011},
  DOI = {10.1097/{QAI}.0b013e31821f596c},
  URL = {https://www.documentation.ird.fr/hor/fdi:010053681},
}