Background: In sub-Saharan Africa, most HIV-infected patients receive antiretroviral therapy (ART) without virological monitoring. Longitudinal data on secondary resistance are rare.
Methods: We conducted a prospective cohort study of HIV-1–infected adults initiating ART in 3 clinics using computerized monitoring systems. Patients had plasma HIV-1 RNA viral load (VL) tests at months 12 (M12) and 24 (M24) after ART initiation and HIV-1 resistance genotype tests if VL was detectable (≥300 copies/mL).
Results: Overall, 1573 patients initiated ART with stavudine/zidovudine plus lamivudine plus nevirapine/efavirenz. At M12 and M24, 944 and 844 patients, respectively, remained in active follow-up. Among them, 25% (M12) and 27% (M24) had detectable VLs and 12% (M12) and 19% (M24) had virus resistant to at least 1 antiretroviral drug, accounting for 54% (M12) and 75% (M24) of patients with detectable VLs. Among the resistant strains, 95% (M12) and 97% (M24) were resistant to lamivudine/emtricitabine, efavirenz, and/or nevirapine, the frequency of thymidine analog mutations increased from 8.1% (M12) to 14.7% (M24) and etravirine resistance increased from 13.5% (M12) to 24.5% (M24).
Conclusions: Of the patients with detectable VLs at M24, 25% still did not harbor resistant virus. Preventing mutations from emerging with adherence reinforcement in patients with detectable VLs remains important beyond M24. Switching therapy early in patients with resistance to 3 TC/FTC and/or to nonnucleoside reverse transcriptase inhibitors to prevent extended resistance to nucleoside reverse transcriptase inhibitors and etravirine resistance from occurring is also a major challenge.
*Programme PAC-CI/ANRS, Abidjan, Côte d’Ivoire;
†INSERM, Centre 897, France;
‡University of Bordeaux, ISPED, France;
§Laboratoire de Virologie, Université Paris Descartes, Sorbonne Paris Cité, AP-HP, CHU Necker-Enfants Malades, Paris;
‖CeDReS, CHU de Treichville, Abidjan, Côte d’Ivoire; and
¶Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte d’Ivoire.
Correspondence to: Xavier Anglaret, MD, PhD, Programme PAC-CI/ANRS, 69, CHU de Treichville, 18 BP 1954, Abidjan 18, Côte d’Ivoire (e-mail: firstname.lastname@example.org).
The Agence Nationale de Recherches sur le SIDA et les hepatites virales (grants ANRS 12136 and ANRS 12212), the programme “Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau”—ESTHER (Network for Therapeutic Solidarity in Hospitals), the National Institute of Allergy and Infectious Diseases (grants R01 AI058736 and K24 AI062476), and the National Institutes of Health (IeDEA West Africa Collaboration, grant 12,273).
E. M. and M. L. C. are currently receiving a grant (ANRS 12186) from the French National Agency for or Research on AIDS and viral hepatitis (ANRS, Paris, France). For the remaining authors, none were declared.
The authors have no conflicts of interest to disclose.
Received February 10, 2013
Accepted April 26, 2013