@article{fdi:010058203,
  title = {{V}irological failure rates and {HIV}-1 drug resistance patterns in patients on first-line antiretroviral treatment in semirural and rural {G}abon},
  author = {{L}i{\'e}geois, {F}lorian and {V}ella, {C}. and {E}ymard-{D}uvernay, {S}abrina and {S}ica, {J}. and {M}akosso, {L}. and {M}ouinga-{O}nd{\'e}m{\'e}, {A}. and {M}ongo, {A}. {D}. and {B}ou{\'e}, {V}. and {B}utel, {C}hristelle and {P}eeters, {M}artine and {G}onzalez, {J}ean-{P}aul and {D}elaporte, {E}ric and {R}ouet, {F}.},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction: {A}s antiretroviral treatment ({ART}) continues to expand in resource-limited countries, the emergence of {HIV} drug resistance mutations ({DRM}s) is challenging in these settings. {I}n {G}abon (central {A}frica), no study has yet reported the virological effectiveness of initial {ART} given through routine {HIV} care. {M}ethods: {F}ollowing the {W}orld {H}ealth {O}rganization ({WHO}) recommendations, a cross-sectional study with a one-time {HIV}-1 {RNA} viral load ({VL}) measurement was conducted in {G}abon to assess virological failure ({VF}) defined by a {VL} result >= 1000 copies/ml and {DRM}s among adult patients living with non-{B} {HIV}-1 strains and receiving first-line non-nucleoside reverse transcriptase inhibitor ({NNRTI})-based antiretroviral therapy for at least 12 months. {R}isk factors associated with {VF} and {DRM}s were assessed. {R}esults: {B}etween {M}arch 2010 and {M}arch 2011, a total of 375 patients were consecutively enrolled from two decentralized (one semirural and one rural) {HIV} care centres. {M}edian time on {ART} was 33.6 months (range, 12-107). {O}verall, the rate of {VF} was 41.3% (36.4-46.4). {A}mong viremic patients, 56.7% (80/141) had at least one {DRM} and 37.6% had dual-class resistance to nucleoside reverse transcriptase inhibitors ({NRTI}s) and {NNRTI}s. {T}he most frequent {DRM}s were {K}103{N}/{S} (46.1%) and {M}184{V}/{I} (37.6%). {T}hymidine analogue mutations were found in 10.6%. {I}ndependent risk factors associated with {VF} were being followed up at the semirural centre ({P} = 0.033), having experienced unstructured treatment interruptions ({P} = 0.0044), and having low {CD}4(+) counts at enrolment ({P}<0.0001). {A} longer time on {ART} ({P} = 0.0008) and being followed up at the rural centre ({P} = 0.021) were risk factors for {DRM}s. {C}onclusions: {T}his is the first study conducted in {G}abon providing {VF} rates and {DRM} patterns in adult patients receiving first-line {ART}. {I}n sub-{S}aharan {A}frica, where {NNRTI}-based regimens are recommended as the standard for first-line {ART}, strengthening virological monitoring together with preventing unplanned treatment interruptions are a global public health priority.},
  keywords = {{HIV} ; {A}frica ; antiretroviral therapy ; viral load ; resistance},
  booktitle = {},
  journal = {{J}ournal of the {I}nternational {A}ids {S}ociety},
  volume = {15},
  numero = {},
  pages = {17985},
  ISSN = {1758-2652},
  year = {2012},
  DOI = {10.7448/ias.15.2.17985},
  URL = {https://www.documentation.ird.fr/hor/fdi:010058203},
}