@article{fdi:010082065,
  title = {{H}igh rate of virological failure and {HIV} drug resistance in semi-rural {G}abon and implications for dolutegravir-based regimen efficacy},
  author = {{E}ngone-{O}ndo, {J}. {D}. and {M}ouinga-{O}ndeme, {A}. and {L}ekana-{D}ouki, {S}. {E}. and {D}iane, {A}. and {M}amimandjiami, {A}. {I}. and {B}anga, {O}. and {N}dong-{A}tome, {G}. {R}. and {A}ghokeng {F}obang, {A}velin},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {T}he projected {UNAIDS} goal of ending {AIDS} by 2030 requires significant global efforts to improve current and future {ART} strategies. {I}n this study, we assessed viral load ({VL}) suppression and acquired drug resistance, as well as future efficacy of dolutegravir-based combinations for patients {L}iving in semi-rural regions of {G}abon. {M}ethods: {E}ligible study participants were adults receiving {ART} and recruited between 2018 and 2019 in {F}ranceville, {G}abon. {VL} testing was conducted to assess {VL} suppression and {HIV} drug resistance ({HIVDR}) testing was performed to identify resistance mutations and assess their impact on ongoing and future {ART} regimens. {R}esults: {W}e recruited 219 participants overall {T}he median time on {ART} was 27 months and 216/219 participants were on first-{L}ine {ART}. {VL} suppression ({VL} <1000 copies/m{L}) was 57.1% (95% {CI} 50.5-63.8) overall; 59.4% (51.4-67.5) and 52.2% (40.3-64.2) for women and men, respectively. {T}he overall prevalence of {HIVDR} was 21.9% among the study population and 67.2% among those who failed {ART}. {P}resence of both {NRTI} and {NNRTI} mutations was found in 84.6% of sequences with drug resistance mutations, and full activity of a dolutegra-virbased first-line regimen including tenofovir disoproxil fumarate/lamivudin/dolutegravir was expected only for 5/39 patients with a resistant virus. {C}onclusions: {T}his study shows a very {L}ow rate of {VL} suppression in a semi-rural context in {A}frica. {M}oreover, the high burden of {HIVDR} has affected both current and newly recommended {ART} strategies. {B}etter management of {ART} in resource-{L}imited settings is still a challenging ambition.},
  keywords = {{GABON} ; {FRANCEVILLE}},
  booktitle = {},
  journal = {{J}ournal of {A}ntimicrobial {C}hemotherapy},
  volume = {76},
  numero = {4},
  pages = {1051--1056},
  ISSN = {0305-7453},
  year = {2021},
  DOI = {10.1093/jac/dkaa537},
  URL = {https://www.documentation.ird.fr/hor/fdi:010082065},
}