Low Prevalence of Detectable HIV Plasma Viremia in Patients Treated With Antiretroviral Therapy in Burkina Faso and Mali

Boileau, Cathérine; Nguyen, Vinh-Kim; Sylla, Mohamed; Machouf, Nimâ; Chamberland, Annie; Traore, H; Niamba, P.; Diallo, I; Maïga, M. Y.; Cissé, Mamadou; Rashed, S.; Tremblay, Cécile

doi:10.1097/qai.0b013e31817dc416

Cited by 25 publications

(21 citation statements)

References 42 publications

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“…Factors associated with detectable viremia included distance from the clinic [odds ratio (OR) 2.48, 95% CI 1.79-5.82] and treatment interruptions (OR 2.36, 95% CI 1. 35-4.15) [47].…”

Section: Treatment Failure In Resource-limited Settingsmentioning

confidence: 97%

“…Treatment failure thus continues to be defined primarily on clinical and immunologic grounds. A cohort of 606 individuals in West Africa, for whom viral loads were available, found an overall rate of virologic failure (defined as a viral load >500 copies/ml after 6 months) of 14%, of which 71% had viral load above 10 000 copies/ml [47]. Factors associated with detectable viremia included distance from the clinic [odds ratio (OR) 2.48, 95% CI 1.79-5.82] and treatment interruptions (OR 2.36, 95% CI 1.…”

Section: Treatment Failure In Resource-limited Settingsmentioning

confidence: 99%

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Epidemiology of treatment failure: a focus on recent trends

Hull

Lima

Hogg

et al. 2009

Current Opinion in HIV and AIDS

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There has been a reassuring decrease in the frequency of virological failure and drug resistance in the modern highly active antiretroviral therapy era. This observation provides an important incentive to strengthen support of antiretroviral therapy programs to optimize virological outcomes, particularly in resource-limited settings in which access to newer agents and laboratory monitoring may be needed to ensure sustainable success.

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“…Factors associated with detectable viremia included distance from the clinic [odds ratio (OR) 2.48, 95% CI 1.79-5.82] and treatment interruptions (OR 2.36, 95% CI 1. 35-4.15) [47].…”

Section: Treatment Failure In Resource-limited Settingsmentioning

confidence: 97%

Section: Treatment Failure In Resource-limited Settingsmentioning

confidence: 99%

Epidemiology of treatment failure: a focus on recent trends

Hull

Lima

Hogg

et al. 2009

Current Opinion in HIV and AIDS

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“…High and sustainable efficacy, similar to that achieved in industrialised settings, can be obtained despite frequent treatment initiation at a later stage of HIV disease progression [1-4]. Beside individual benefits, HAART also has potential public health benefits [5], through reduced HIV genital shedding [6] and decreased transmission [7-10], which forms the core hypothesis of the much debated 'Treatment as Prevention' concept [11].…”

Section: Introductionmentioning

confidence: 99%

Long term virological, immunological and mortality outcomes in a cohort of HIV-infected female sex workers treated with highly active antiretroviral therapy in Africa

et al. 2011

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BackgroundConcerns have been raised that marginalised populations may not achieve adequate compliance to antiretroviral therapy. Our objective was to describe the long-term virological, immunological and mortality outcomes of providing highly active antiretroviral therapy (HAART) with strong adherence support to HIV-infected female sex workers (FSWs) in Burkina Faso and contrast outcomes with those obtained in a cohort of regular HIV-infected women.MethodsProspective study of FSWs and non-FSWs initiated on HAART between August 2004 and October 2007. Patients were followed monthly for drug adherence (interview and pill count), and at 6-monthly intervals for monitoring CD4 counts and HIV-1 plasma viral loads (PVLs) and clinical events.Results95 women, including 47 FSWs, were followed for a median of 32 months (interquartile range [IQR], 20-41). At HAART initiation, the median CD4 count was 147 cells/μl (IQR, 79-183) and 144 cells/μl (100-197), and the mean PVLs were 4.94 log10copies/ml (95% confidence interval [CI], 4.70-5.18) and 5.15 log10 copies/ml (4.97-5.33), in FSWs and non-FSWs, respectively. Four FSWs died during follow-up (mortality rate: 1.7 per 100 person-years) and none among other women. At 36 months, the median CD4 count increase was 230 cells/μl (IQR, 90-400) in FSWs vs. 284 cells/μl (193-420) in non-FSWs; PVL was undetectable in 81.8% (95% CI, 59.7-94.8) of FSWs vs. 100% (83.9-100) of non-FSWs; and high adherence to HAART (> 95% pills taken) was reported by 83.3% (95% CI, 67.2-93.6), 92.1% (95% CI, 78.6-98.3), and 100% (95% CI, 54.1-100) of FSWs at 6, 12, and 36 months after HAART initiation, respectively, with no statistical difference compared to the pattern observed among non-FSWs.ConclusionsClinical and biological benefits of HAART can be maintained over the long term among FSWs in Africa and could also lead to important public health benefits.

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“…The early assessment of ART efficacy in these treated patients has been similar to that described in ART treatment trials in the developed world. [28][29][30] However, the durability of these responses has yet to be well studied. Critical to the sustainability of these treatment responses and ultimate success of these programs is the surveillance of drug resistance in both untreated and treated populations.…”

Section: Introductionmentioning

confidence: 99%

Impact of HIV Type 1 Subtype on Drug Resistance Mutations in Nigerian Patients Failing First-Line Therapy

Chaplin

Eisen

Idoko

et al. 2011

AIDS Research and Human Retroviruses

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A diverse array of non-subtype B HIV-1 viruses circulates in Africa and dominates the global pandemic. It is important to understand how drug resistance mutations in non-B subtypes may develop differently from the patterns described in subtype B. HIV-1 reverse transcriptase and protease sequences from 338 patients with treatment failure to first-line ART regimens were evaluated. Multivariate logistic regression was used to examine the effect of subtype on each mutation controlling for regimen, time on therapy, and total mutations. The distribution of HIV-1 subtypes included CRF02_AG (45.0%), G (37.9%), CRF06_cpx (4.4%), A (3.6%), and other subtypes or recombinant sequences (9.2%). The most common NRTI mutations were M184V (89.1%) and thymidine analog mutations (TAMs). The most common NNRTI mutations were Y181C (49.7%), K103N (36.4%), G190A (26.3%), and A98G (19.5%). Multivariate analysis showed that CRF02_AG was less likely to have the M41L mutation compared to other subtypes [adjusted odds ratio (AOR) ¼ 0.35; p ¼ 0.022]. Subtype A patients showed a 42.5-fold increased risk (AOR ¼ 42.5, p ¼ 0.001) for the L210W mutation. Among NNRTI mutations, subtype G patients had an increased risk for A98G (AOR ¼ 2.40, p ¼ 0.036) and V106I (AOR ¼ 6.15, p ¼ 0.010), whereas subtype CRF02_AG patients had an increased risk for V90I (AOR ¼ 3.16; p ¼ 0.003) and a decreased risk for A98G (AOR ¼ 0.48, p ¼ 0.019). Five RT mutations were found to vary significantly between different non-B West African subtypes. Further study to understand the clinical impact of subtype-specific diversity on drug resistance will be critically important to the continued success of ART scale-up in resource-limited settings.

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Low Prevalence of Detectable HIV Plasma Viremia in Patients Treated With Antiretroviral Therapy in Burkina Faso and Mali

Abstract: Sufficient expertise and dedication exist in public hospital and community-based programs to achieve rates of treatment success comparable to better-resourced settings.

Cited by 25 publications

References 42 publications

Epidemiology of treatment failure: a focus on recent trends

Epidemiology of treatment failure: a focus on recent trends

Long term virological, immunological and mortality outcomes in a cohort of HIV-infected female sex workers treated with highly active antiretroviral therapy in Africa

Impact of HIV Type 1 Subtype on Drug Resistance Mutations in Nigerian Patients Failing First-Line Therapy

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