Virological failure after 1 year of first-line ART is not associated with HIV minority drug resistance in rural Cameroon

Zoufaly, Alexander; Jochum, Johannes; Hammerl, Raffaela; Nassimi, Nilofar; Raymond, Yurika; Burchard, Gerd; Schmiedel, Stefan; Drexler, Jan Felix; Campbell, Nottania K.; Taka, Nchang; Awasom, Charles; Metzner, Karin J.; Lunzen, Jan van; Feldt, Torsten

doi:10.1093/jac/dku470

Cited by 25 publications

(22 citation statements)

References 16 publications

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“…Kyeyune et al, reported the presence of DRMs in low frequency only for 65% of Ugandan patients failing cART [45]. However, in other studies no association between VF and the presence of low-frequency drug resistant variants was observed[46, 47]. …”

Section: Discussionmentioning

confidence: 99%

Decreased emergence of HIV-1 drug resistance mutations in a cohort of Ugandan women initiating option B+ for PMTCT

et al. 2017

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BackgroundSince 2012, WHO guidelines for the prevention of mother-to-child transmission (PMTCT) of HIV-1 in resource-limited settings recommend the initiation of lifelong antiretroviral combination therapy (cART) for all pregnant HIV-1 positive women independent of CD4 count and WHO clinical stage (Option B+). However, long-term outcomes regarding development of drug resistance are lacking until now. Therefore, we analysed the emergence of drug resistance mutations (DRMs) in women initiating Option B+ in Fort Portal, Uganda, at 12 and 18 months postpartum (ppm).Methods and findings124 HIV-1 positive pregnant women were enrolled within antenatal care services in Fort Portal, Uganda. Blood samples were collected at the first visit prior starting Option B+ and postpartum at week six, month six, 12 and 18. Viral load was determined by real-time RT-PCR. An RT-PCR covering resistance associated positions in the protease and reverse transcriptase HIV-1 genomic region was performed. PCR-positive samples at 12/18 ppm and respective baseline samples were analysed by next generation sequencing regarding HIV-1 drug resistant variants including low-frequency variants. Furthermore, vertical transmission of HIV-1 was analysed. 49/124 (39.5%) women were included into the DRM analysis. Virological failure, defined as >1000 copies HIV-1 RNA/ml, was observed in three and seven women at 12 and 18 ppm, respectively. Sequences were obtained for three and six of these. In total, DRMs were detected in 3/49 (6.1%) women. Two women displayed dual-class resistance against all recommended first-line regimen drugs. Of 49 mother-infant-pairs no infant was HIV-1 positive at 12 or 18 ppm.ConclusionOur findings suggest that the WHO-recommended Option B+ for PMTCT is effective in a cohort of Ugandan HIV-1 positive pregnant women with regard to the low selection rate of DRMs and vertical transmission. Therefore, these results are encouraging for other countries considering the implementation of lifelong cART for all pregnant HIV-1 positive women.

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Section: Discussionmentioning

confidence: 99%

Decreased emergence of HIV-1 drug resistance mutations in a cohort of Ugandan women initiating option B+ for PMTCT

et al. 2017

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“…The variation in proportion of patients failing first-line ART observed in the field is remarkably high and variable, ranging from 8 to 16.9% in Africa [11][12][13][14][15][16][17][18][19] and from 8.9 to 13% elsewhere [20][21][22]. The few retrospective studies conducted at Accredited HIV Care Center (AHCC) in the Northwest, Southwest and Littoral regions of Cameroon have shown treatment failure on first-line ART between16 and 23.2% [2,[23][24][25]. The rate of patients switching to second-line ART also varies and ranged from 3.5 to 30% in Africa [26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

First-line antiretroviral treatment and virological response among HIV adult patients at an accredited HIV care center, Cameroon

et al. 2019

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Background: Viral load (VL) monitoring in the clinical follow-up of HIV patients to detect treatment failure is not routinely offered in Cameroon. The study was designed to characterize virological response on antiretroviral treatment (ART) among adults living with HIV and to identify predictors of virological failure (VF). Methods: Between November 2014 and January 2016, a prospective, population-based cohort study was conducted among HIV-positive adults under first-line treatment and monitored at the Accredited HIV Care Center (AHCC) of Laquintinie Hospital of Douala. Clinical and biological data at the initiation of ART were collected from patients' medical records. HIV VL at 12 and 24 months after the patient started treatment on ART were performed using quantitative real-time PCR protocol with the generic HIV Roche TaqMan assay. Descriptive and logistic regression analysis were performed in Stata SE11 version in data analysis. Results: Overall 150 (45.5%) of 330 adults living with HIV were tested with at least one VL, and of these patients, 51 (34.0%) were tested with two VL during the followed-up. The VF was observed in 13 of 51 (25.5%) patients and among them, 8 (61.5%) switched to second-line ART regimens. Thirty-five (68.6%) of the 51 patients had an undetectable VL at the first VL measurement, and seven (13.7%) patients subsequently developed viral load rebound (VLR) on tritherapy. Using a multivariate analysis, the risk of VF was seven times higher in HIV adults who did not respect the medication hours (OR = 7.38, 95%CI = 1.56-34.90, p = 0.012) and eleven times higher in patients with none or primary school education (OR = 11.38, 95% CI = 2.41-53.76, p = 0.002). Conclusion: Low education level and poor adherence are the main risk factors for VF. Strengthening therapeutic failure prevention strategies and routine VL surveillance would allow early detection of VF and contribute in achieving the third goal of UNAIDS which recommends "90-90-90" targets for People Living with HIV in resourcelimited settings.

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“…In the reference HIV/AIDS out‐patient clinic of the Central Hospital in Yaoundé in 2006–2009, this proportion was 77% after 24 months of ART and 82% after 36 months . In the Bamenda Regional Hospital in 2010, it was 84% after 12 months of ART . Finally, only 61% of patients had virological suppression after a median time on ART of 24 months in a district hospital located in a very remote area in northern Cameroon in 2009–2011 .…”

Section: Discussionmentioning

confidence: 99%

Heterogeneity of virological suppression in the national antiretroviral programme of Cameroon (ANRS 12288 EVOLCAM)

et al. 2018

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Objectives In terms of HIV infection, western and central Africa is the second most affected region world‐wide, and the gap between the regional figures for the testing and treatment cascade and the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90–90–90 targets is particularly worrying. We assessed the prevalence of virological suppression in patients routinely treated in 19 hospitals in Cameroon. Methods A cross‐sectional survey was performed in adult patients receiving antiretroviral therapy (ART) in the Centre and Littoral regions. The prevalences of virological suppression (<1000 HIV‐1 RNA copies/mL) were compared among all 19 hospitals using the χ2 test. Potential individual and health care‐related determinants of virological suppression were assessed using multivariate logistic regression models. Results A total of 1700 patients (74% women; median age 41 years; median time on ART 3.7 years) were included in the study. The prevalence of virological suppression was 82.4% overall (95% confidence interval 80.5–84.2%). It ranged from 57.1 to 97.4% according to the individual hospital (P < 0.001). After adjustment, virological suppression was associated with age, CD4 cell count at ART initiation, disclosure of HIV status to family members, interruption of ART for more than two consecutive days, and location of patient's residence and hospital (rural/urban). These factors did not explain the heterogeneity of virological suppression between the study hospitals (P < 0.001). Conclusions The overall prevalence of virological suppression was reassuring. Nevertheless, the heterogeneity of virological suppression among hospitals highlights that, in addition to programme‐level data, health facility‐level data are crucial in order to tailor the national AIDS programme's interventions with a view to achieving the third UNAIDS 90 target.

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Virological failure after 1 year of first-line ART is not associated with HIV minority drug resistance in rural Cameroon

Abstract: Virological failure after 1 year of ART was not associated with minority drug resistance at baseline but with incomplete adherence. Strategies to assure adherence and uninterrupted drug supplies are pivotal factors for therapy success.

Cited by 25 publications

References 16 publications

Decreased emergence of HIV-1 drug resistance mutations in a cohort of Ugandan women initiating option B+ for PMTCT

Decreased emergence of HIV-1 drug resistance mutations in a cohort of Ugandan women initiating option B+ for PMTCT

First-line antiretroviral treatment and virological response among HIV adult patients at an accredited HIV care center, Cameroon

Heterogeneity of virological suppression in the national antiretroviral programme of Cameroon (ANRS 12288 EVOLCAM)

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