Resistance to Antiretroviral Drugs in Treated and Drug-Naive Patients in the Democratic Republic of Congo

Muwonga, Jérémie; Edidi, Samuel; Butel, Christelle; Vidal, Nicole; Monleau, Marjorie; Okenge, Augustin; Mandjo, Jean Lambert; Mukumbi, H.; Muyembe, Jean Jacques; Mbayo, Ferdinand; Nzongola, Donatien Kayembe; Delaporte, Eric; Boillot, François; Peeters, Martine

doi:10.1097/qai.0b013e31821f596c

Cited by 29 publications

(25 citation statements)

References 26 publications

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“…ART status was determined by self-report and it is possible that some individuals reported receiving ART even though they were not. The proportion of viraemic individuals in this study is in contrast to cross-sectional studies conducted in sub-Saharan African ART cohorts reporting a prevalence of viraemia of 15% among patients receiving ART for 12 months or longer [44,45,46]. A possible explanation for the marked difference in the proportion of viraemic individuals in this population-based study and clinic-based cross-sectional studies is the Hawthorne effect.…”

Section: Discussioncontrasting

confidence: 87%

Community Viral Load and CD4 Count Distribution Among People Living With HIV in a South African Township

Kranzer

Lawn

Johnson

et al. 2013

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction The goals of scale-up of antiretroviral therapy (ART) have expanded from prevention of morbidity and death to include prevention of transmission. Morbidity and mortality risk are associated with CD4 counts; transmission risk depends on plasma viral load (VL). This study aimed to describe CD4 count and VL distributions among HIV-infected individuals in a South African township to gain insights into the potential impact of ART scale-up on community HIV transmission risk. Methods A random sample of 10% of the adult population was invited to attend an HIV testing service. Study procedures included a questionnaire, HIV testing, CD4 count and VL testing. Results 1144 (88.0%) of 1300 randomly selected individuals participated in the study. 260 tested positive, giving an HIV prevalence of 22.7% (95%CI:20.3-25.3). A third of all HIV-infected individuals (33.5%, 95%CI:27.8-39.6) reported taking ART. The median CD4 count was 417 cells/μl (IQR:285-627); 33 (12.7%, 95%CI:8.9-17.4) had a CD4 count of ≤200 cells/μL. VL measurements were available for 219 (84.2%) individuals and were undetectable in 72 (33.9%), >1500 copies/ml in 127 (58.0%) and >10,000 copies/ml in 96 (43.8%). Of those reporting they were receiving ART, 30.4% had a VL>1500 copies/ml compared to 58.0% of those reporting they were not receiving ART. Conclusion A small proportion of those living with HIV in this community had a CD4 count <200 cells/μl; more than half had a VL high enough to be associated with considerable transmission risk. A substantial proportion of HIV-infected individuals remained at risk of transmitting HIV even after starting ART.

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Section: Discussioncontrasting

confidence: 87%

Community Viral Load and CD4 Count Distribution Among People Living With HIV in a South African Township

Kranzer

Lawn

Johnson

et al. 2013

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Compared with other west and central African countries, our estimations were among the highest [11, 18–20]. It is of interest to note that our estimations were comparable to those found in rural Togo, but, in contrast to Cameroon, virologic failure tended to be comparable between rural and urban areas in this country [11, 21].…”

Section: Discussionsupporting

confidence: 67%

“…By contrast, men were more vulnerable to virologic failure than women in other studies [18, 24–26]. One of these studies was performed in 9 district hospitals (including the Mfou one) in the same region of Cameroon as the present study [27].…”

Section: Discussionmentioning

confidence: 87%

Virologic Failure and Human Immunodeficiency Virus Drug Resistance in Rural Cameroon With Regard to the UNAIDS 90-90-90 Treatment Targets

Boullé

Guichet

Kouanfack

et al. 2016

Open Forum Infectious Diseases

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Background.In rural Africa, data on virologic effectiveness of antiretroviral treatment (ART) are not sufficient to assess the gap with the UNAIDS 90-90-90 treatment targets. We investigated the prevalences of unsuppressed viral load and antiretroviral drug resistance and the profile of genotypic resistance mutations among patients routinely treated in rural Cameroon.Methods.A cross-sectional study was performed in 2013–2014 among patients ≥15 years and on first-line ART for ≥6 months in a district hospital. Patients were offered free access to human immunodeficiency virus viral load testing. Genotypic drug resistance testing was done when the viral load was >1000 copies/mL. Multivariate logistic regression models were used to assess the relationship of unsuppressed viral load or antiretroviral drug resistance with sociodemographic and medical characteristics.Results.Of 407 patients (women 74.9%, median age 41.8 years, median time on ART 29.2 months), 96 (23.6%; 95% confidence interval [CI], 19.5–28.0) had unsuppressed viral load and 74 (18.2%; 95% CI, 14.6–22.3) had antiretroviral drug resistance. The prevalences of unsuppressed viral load and resistance increased with time on ART, from 12.0% and 8.0% in the 6- to 12-month group to 31.3% and 27.1% in the >72-month group, respectively. All 74 patients with antiretroviral drug resistance were resistant to nonnucleoside reverse-transcriptase inhibitors, and 57 of them were also resistant to nucleoside reverse-transcriptase inhibitors.Conclusions.Our estimations were among the highest observed in the west and central African region. The proportion of patients with virologic failure should be divided at least by 2 to reach the UNAIDS 90-90-90 treatment targets.

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“…In particular, very comparable strengths of association between gender and virologic response were reported in the DART (Development of AntiRetroviral Therapy in Africa) study in Uganda and Zimbabwe (adjusted OR 2.87, 95% CI: 1.66–4.98; p< 0.001) and in another study in Uganda (crude OR 2.14, 95% CI: 0.99–4.63; p= 0.05) [22,23]. Also, measurable HIV loads were found in 25.7% of men vs. 16.9% of women ( p= 0.012) in the Democratic Republic of Congo and in 55% of men vs. 31% of women ( p= 0.003) in Tanzania [24,25]. Conversely, gender was not associated with virologic failure in studies in South Africa, Malawi and Senegal [11,13,26,28,29].…”

Section: Discussionmentioning

confidence: 92%

The vulnerability of men to virologic failure during antiretroviral therapy in a public routine clinic in Burkina Faso

Penot

Hema

Bado

et al. 2014

Journal of the International AIDS Society

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IntroductionGender differences in antiretroviral therapy (ART) outcomes are critical in sub-Saharan Africa. We assessed the association between gender and virologic failure among adult patients treated in a public routine clinic (one of the largest in West Africa) in Burkina Faso.MethodsWe performed a case-control study between July and October 2012 among patients who had received ART at the Bobo Dioulasso Day Care Unit. Patients were eligible if they were 15 years or older, positive for HIV-1 or HIV-1+2, and on first-line ART for at least six months. Cases were all patients with two consecutive HIV loads >1000 copies/mL (Biocentric Generic or Abbott Real Time assays), or one HIV load >1000 copies/mL associated with immunologic or clinical failure criteria. Controls were all patients who only had HIV loads <300 copies/mL. The association between gender and virologic failure was assessed using a multivariate logistic regression, adjusted on age, level of education, baseline CD4+ T cell count, first and current antiretroviral regimens and time on ART.ResultsOf 2303 patients (74.2% women; median age: 40 years; median time on ART: 34 months), 172 had virologic failure and 2131 had virologic success. Among the former, 130 (75.6%) had confirmed virologic failure, 38 (22.1%) had viro-immunologic failure, and four (2.3%) had viro-clinical failure. The proportion of men was significantly higher among the cases than among the controls (37.2% vs. 24.9%; p<0.001). Compared to controls, cases were also younger, more immunodeficient at ART initiation, less likely to receive a protease inhibitor-based antiretroviral regimen and had spent a longer period of time on ART. After adjustment, male gender remained strongly associated with virologic failure (odds ratio 2.52, 95% CI: 1.77–3.60; p<0.001).ConclusionsMen on ART appeared more vulnerable to virologic failure than women. Additional studies are needed to confirm the poorer prognosis of men in this setting and to determine the causes for their vulnerability in order to optimize HIV care. From now on, efforts should be made to support the adherence of men to ART in the African setting.

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Resistance to Antiretroviral Drugs in Treated and Drug-Naive Patients in the Democratic Republic of Congo

Abstract: The accumulation of drug resistance mutations with time on ART needs further attention, and surveillance should be reinforced in ART programs in sub-Saharan Africa.

Cited by 29 publications

References 26 publications

Community Viral Load and CD4 Count Distribution Among People Living With HIV in a South African Township

Community Viral Load and CD4 Count Distribution Among People Living With HIV in a South African Township

Virologic Failure and Human Immunodeficiency Virus Drug Resistance in Rural Cameroon With Regard to the UNAIDS 90-90-90 Treatment Targets

The vulnerability of men to virologic failure during antiretroviral therapy in a public routine clinic in Burkina Faso

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