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- Title
High level of HIV-1 resistance in patients failing long-term first-line antiretroviral therapy in Mali.
- Authors
Fofana, D. B.; Soulié, C.; Baldé, A.; Lambert-Niclot, S.; Sylla, M.; Ait-Arkoub, Z.; Diallo, F.; Sangaré, B.; Cissé, M.; Maïga, I. A.; Fourati, S.; Koita, O.; Calvez, V.; Marcelin, A. G.; Maïga, A. I.
- Abstract
Objectives In resource-limited settings, few data are available on virological failure after long-term first-line antiretroviral therapy. This study characterized the genotypic resistance patterns at the time of failure after at least 36 months of a first-line regimen in Mali, West Africa. Methods Plasma samples from 84 patients who were receiving first-line antiretroviral treatment and with an HIV-1 RNA viral load (VL) >1000 copies/mL were analysed. Genotypic resistance testing was performed and HIV-1 drug resistance was interpreted according to the latest version of the National Agency for HIV and Hepatitis Research algorithm. Results At the time of resistance testing, patients had been treated for a median of 60 months (IQR 36–132 months) and had a median CD4 cell count of 292 cells/mm3 (IQR 6–1319 cells/mm3), a median HIV-1 RNA level of 28 266 copies/mL (IQR 1000–2 938 495 copies/mL) and a median genotypic susceptibility score of 1 (IQR 1–4). The prevalence of nucleoside reverse transcriptase inhibitor (NRTI) and non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance mutations was 78% and 82%, respectively. Viruses were resistant to at least one drug in 92% of cases. Although etravirine and rilpivirine were not used in the first-line regimens, viruses were resistant to etravirine in 34% of cases and to rilpivirine in 49% of cases. The treatment duration, median number of NRTI and NNRTI mutations and some reverse transcriptase mutations (T215Y/F/N, L210W, L74I, M41L and H221Y) were associated with the VL at virological failure. Conclusions This study demonstrated a high level of resistance to NRTIs and NNRTIs, compromising second-generation NNRTIs, for patients who stayed on long-term first-line regimens. It is crucial to expand the accessibility of virological testing in resource-limited settings to limit the expansion of resistance and preserve second-line treatment efficacy.
- Subjects
MALI; ANTIRETROVIRAL agents; DRUG resistance; HIV infections; THERAPEUTICS; REVERSE transcriptase inhibitors; NUCLEOSIDE reverse transcriptase inhibitors; ETRAVIRINE (Drug); ANTI-HIV agents; PUBLIC health
- Publication
Journal of Antimicrobial Chemotherapy (JAC), 2014, Vol 69, Issue 9, p2531
- ISSN
0305-7453
- Publication type
Article
- DOI
10.1093/jac/dku153