Resistance profiles after different periods of exposure to a first-line antiretroviral regimen in a Cameroonian cohort of HIV type-1-infected patients.
dc.contributor.author | Soria, A | |
dc.contributor.author | Porten, K | |
dc.contributor.author | Fampou-Toundji, J | |
dc.contributor.author | Galli, L | |
dc.contributor.author | Mougnutou, R | |
dc.contributor.author | Buard, V | |
dc.contributor.author | Kfutwah, A | |
dc.contributor.author | Vessière, A | |
dc.contributor.author | Rousset, D | |
dc.contributor.author | Teck, R | |
dc.contributor.author | Calmy, A | |
dc.contributor.author | Ciaffi, L | |
dc.contributor.author | Lazzarin, A | |
dc.contributor.author | Gianotti, N | |
dc.date.accessioned | 2009-09-20T23:37:36Z | |
dc.date.available | 2009-09-20T23:37:36Z | |
dc.date.issued | 2009-08 | |
dc.identifier.citation | Resistance profiles after different periods of exposure to a first-line antiretroviral regimen in a Cameroonian cohort of HIV type-1-infected patients. 2009, 14 (3):339-47 Antivir. Ther. (Lond.) | en |
dc.identifier.issn | 1359-6535 | |
dc.identifier.pmid | 19474468 | |
dc.identifier.uri | http://hdl.handle.net/10144/81753 | |
dc.description.abstract | BACKGROUND: The lack of HIV type-1 (HIV-1) viral load (VL) monitoring in resource-limited settings might favour the accumulation of resistance mutations and thus hamper second-line treatment efficacy. We investigated the factors associated with resistance after the initiation of antiretroviral therapy (ART) in the absence of virological monitoring. METHODS: Cross-sectional VL sampling of HIV-1-infected patients receiving first-line ART (nevirapine or efavirenz plus stavudine or zidovudine plus lamivudine) was carried out; those with a detectable VL were genotyped. RESULTS: Of the 573 patients undergoing VL sampling, 84 were genotyped. The mean number of nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) mutations increased with the duration of ART exposure (P=0.02). Multivariable analysis showed that patients with a CD4+ T-cell count < or =50 cells/mm(3) at ART initiation (baseline) had a higher mean number of both NRTI and non-NRTI (NNRTI) mutations than those with a baseline CD4+ T-cell count >50 cells/mm(3) (2.10 versus 0.56; P<0.0001; and 1.65 versus 0.76; P=0.005, respectively). A baseline CD4+ T-cell count < or =50 cells/mm(3) predicted > or =1 NRTI mutation (adjusted odds ratio [AOR] 7.49, 95% confidence interval [CI] 2.20-32.14), > or =1 NNRTI mutation (AOR 4.25, 95% CI 1.36-15.48), > or =1 thymidine analogue mutation (AOR 8.45, 95% CI 2.16-40.16) and resistance to didanosine (AOR 6.36, 95% CI 1.49-32.29) and etravirine (AOR 4.72, 95% CI 1.53-15.70). CONCLUSIONS: Without VL monitoring, the risk of drug resistance increases with the duration of ART and is associated with lower CD4+ T-cell counts at ART initiation. These data might help define strategies to preserve second-line treatment options in resource-limited settings. | |
dc.language.iso | en | en |
dc.relation.url | http://www.intmedpress.com | en |
dc.rights | Archived on this site with kind permission of International Medical Press. http://www.intmedpress.com | en |
dc.subject.mesh | Adult | en |
dc.subject.mesh | Anti-HIV Agents | en |
dc.subject.mesh | Antiretroviral Therapy, Highly Active | en |
dc.subject.mesh | CD4 Lymphocyte Count | en |
dc.subject.mesh | Cameroon | en |
dc.subject.mesh | Cohort Studies | en |
dc.subject.mesh | Cross-Sectional Studies | en |
dc.subject.mesh | Drug Resistance, Multiple, Viral | en |
dc.subject.mesh | Female | en |
dc.subject.mesh | HIV Infections | en |
dc.subject.mesh | HIV-1 | en |
dc.subject.mesh | Humans | en |
dc.subject.mesh | Male | en |
dc.subject.mesh | Mutation | en |
dc.subject.mesh | Reverse Transcriptase Inhibitors | en |
dc.subject.mesh | Viral Load | en |
dc.title | Resistance profiles after different periods of exposure to a first-line antiretroviral regimen in a Cameroonian cohort of HIV type-1-infected patients. | en |
dc.contributor.department | Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy. a.soria@hsgerardo.org | en |
dc.identifier.journal | Antiviral Therapy | en |
refterms.dateFOA | 2019-03-04T14:26:39Z | |
html.description.abstract | BACKGROUND: The lack of HIV type-1 (HIV-1) viral load (VL) monitoring in resource-limited settings might favour the accumulation of resistance mutations and thus hamper second-line treatment efficacy. We investigated the factors associated with resistance after the initiation of antiretroviral therapy (ART) in the absence of virological monitoring. METHODS: Cross-sectional VL sampling of HIV-1-infected patients receiving first-line ART (nevirapine or efavirenz plus stavudine or zidovudine plus lamivudine) was carried out; those with a detectable VL were genotyped. RESULTS: Of the 573 patients undergoing VL sampling, 84 were genotyped. The mean number of nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) mutations increased with the duration of ART exposure (P=0.02). Multivariable analysis showed that patients with a CD4+ T-cell count < or =50 cells/mm(3) at ART initiation (baseline) had a higher mean number of both NRTI and non-NRTI (NNRTI) mutations than those with a baseline CD4+ T-cell count >50 cells/mm(3) (2.10 versus 0.56; P<0.0001; and 1.65 versus 0.76; P=0.005, respectively). A baseline CD4+ T-cell count < or =50 cells/mm(3) predicted > or =1 NRTI mutation (adjusted odds ratio [AOR] 7.49, 95% confidence interval [CI] 2.20-32.14), > or =1 NNRTI mutation (AOR 4.25, 95% CI 1.36-15.48), > or =1 thymidine analogue mutation (AOR 8.45, 95% CI 2.16-40.16) and resistance to didanosine (AOR 6.36, 95% CI 1.49-32.29) and etravirine (AOR 4.72, 95% CI 1.53-15.70). CONCLUSIONS: Without VL monitoring, the risk of drug resistance increases with the duration of ART and is associated with lower CD4+ T-cell counts at ART initiation. These data might help define strategies to preserve second-line treatment options in resource-limited settings. |