@article{fdi:010058976,
  title = {{V}irological outcome and patterns of {HIV}-1 drug resistance in patients with 36 months' antiretroviral therapy experience in {C}ameroon},
  author = {{A}ghokeng {F}obang, {A}velin and {K}ouanfack, {C}. and {E}ymard-{D}uvernay, {S}abrina and {B}utel, {C}hristelle and {E}doul, {G}. {E}. and {L}aurent, {C}hristian and {K}oulla-{S}hiro, {S}. and {D}elaporte, {E}ric and {M}poudi-{N}gole, {E}. and {P}eeters, {M}artine},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction: {T}he current expansion of antiretroviral treatment ({ART}) in the developing world without routine virological monitoring still raises concerns on the outcome of the strategy in terms of virological success and drug resistance burden. {W}e assessed the virological outcome and drug resistance mutations in patients with 36 months' {ART} experience, and monitored according to the {WHO} public health approach in {C}ameroon. {M}ethods: {W}e consecutively recruited between 2008 and 2009 patients attending a national reference clinic in {Y}aounde - {C}ameroon, for their routine medical visits at month 36 +/- 2. {O}bservance data and treatment histories were extracted from medical records. {B}lood samples were collected for viral load ({VL}) testing and genotyping of drug resistance when {HIV}-1 {RNA} >= 1000 copies/ml. {R}esults: {O}verall, 376 {HIV}-1 infected adults were recruited during the study period. {A}ll, but four who received {PMTCT}, were {ART}-naive at treatment initiation, and 371/376 (98.7%) started on a first-line regimen that included 3{TC} + d4{T}/{AZT} + {NVP}/{EFV}. {S}ixty-six (17.6%) patients experienced virological failure ({VL} >= 1000 copies/ml) and 53 carried a resistant virus, thus representing 81.5% (53/65) of the patients who failed. {F}orty-two out of 53 were resistant to nucleoside and non-nucleoside reverse-transcriptase inhibitors ({NRTI}s + {NNRTI}s), one to protease inhibitors ({PI}) and {NNRTI}s, two to {NRTI}s only and eight to {NNRTI}s only. {A}mong patients with {NRTI} resistance, 18/44 (40.9%) carried {T}hymidine {A}nalog {M}utations ({TAM}s), and 13/44 (29.5%) accumulated at least three {NRTI} resistance mutations. {O}bserved {NNRTI} resistance mutations affected drugs of the regimen, essentially nevirapine and efavirenz, but several patients (10/51, 19.6%) accumulated mutations that may have compromised etravirine use. {C}onclusions: {W}e observed a moderate level of virological failure after 36 months of treatment, but a high proportion of patients who failed developed drug resistance. {A}lthough we found that for the majority of patients, second-line regimens recommended in {C}ameroon would be still effective, accumulated resistance mutations are of concern and may compromise future treatment strategies, stressing the need for virological monitoring in resource-limited settings.},
  keywords = {{HIV}-1 ; treatment outcome ; virological monitoring ; drug resistance ; resource-limited country ; {C}ameroon ; {CAMEROUN}},
  booktitle = {},
  journal = {{J}ournal of the {I}nternational {A}ids {S}ociety},
  volume = {16},
  numero = {},
  pages = {18004},
  ISSN = {1758-2652},
  year = {2013},
  DOI = {10.7448/ias.16.1.18004},
  URL = {https://www.documentation.ird.fr/hor/fdi:010058976},
}