Charpentier Charlotte, Talla Frédéric, Nguepi Evelyne, Si-Mohamed Ali, Bélec Laurent
Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Laboratoire de Virologie, Paris, France.
AIDS Res Hum Retroviruses. 2011 Feb;27(2):221-30. doi: 10.1089/aid.2010.0103. Epub 2010 Oct 26.
The rate of virological failure was assessed in 819 patients followed up by the private sector of Douala, the economic capital of Cameroon, and treated according to the World Health Organization (WHO) recommendations. In addition, genotypic resistance testing was carried out in the subgroup of 75 selected patients representative of the 254 patients in virological and/or immunological failure receiving a first-line (83%) or second-line (17%) regimen. Overall, 36% of patients treated by antiretroviral drugs (ARV) were in virological failure, as assessed by plasma viral load above 3.7 log(10) copies/ml under treatment for more than 6 months. According to the immunological status, 17% of patients showed a CD4 T cell count under 200 cells/mm(3) and 37% under 350 cells/mm(3), indicating either ongoing immunorestoration or immunological failure under treatment. Twenty percent of patients in virological failure showed wild-type viruses susceptible to all ARV, likely indicating poor adherence. However, 80% of them displayed plasma virus resistant at least to one ARV drug, mostly to the nucleoside reverse transcriptase inhibitors (NRTIs) class (80%), followed by the non-NRTI class (76%) and the protease inhibitor class (19%), thus reflecting the therapeutic usage of ARV drugs in Cameroon as recommended by the WHO. Whereas the second-line regimen proposed by the 2009 WHO recommendations could be effective in more than 75% of patients in virological failure with resistant viruses, the remaining patients showed a resistance genotypic profile highly predictive of resistance to the usual WHO second-line regimen, including in some patients complex genotypic profiles diagnosed only by genotypic resistance tests. In conclusion, our observations highlight the absolute need for improving viral load assessment in resource-limited settings to prevent and/or monitor therapeutic failure.
在喀麦隆经济首都杜阿拉的私立医疗机构随访的819名患者中评估了病毒学失败率，这些患者均按照世界卫生组织（WHO）的建议接受治疗。此外，在75名选定患者的亚组中进行了基因型耐药性检测，这些患者代表了254名病毒学和/或免疫学失败且接受一线（83%）或二线（17%）治疗方案的患者。总体而言，接受抗逆转录病毒药物（ARV）治疗的患者中有36%出现病毒学失败，这是通过治疗6个月以上血浆病毒载量高于3.7 log(10)拷贝/毫升来评估的。根据免疫状态，17%的患者CD4 T细胞计数低于200个细胞/立方毫米，37%低于350个细胞/立方毫米，这表明治疗期间要么正在进行免疫恢复，要么出现免疫失败。病毒学失败的患者中有20%显示对所有ARV敏感的野生型病毒，这可能表明依从性差。然而，其中80%的患者血浆病毒至少对一种ARV药物耐药，主要是对核苷类逆转录酶抑制剂（NRTIs）类（80%），其次是非NRTI类（76%）和蛋白酶抑制剂类（19%），这反映了喀麦隆按照WHO建议使用ARV药物的治疗情况。尽管WHO 2009年建议提出的二线治疗方案对75%以上病毒学失败且有耐药病毒的患者可能有效，但其余患者显示出对常规WHO二线治疗方案耐药的高度预测性基因型谱，包括一些仅通过基因型耐药性检测诊断出的复杂基因型谱患者。总之，我们的观察结果突出了在资源有限的环境中改善病毒载量评估以预防和/或监测治疗失败的绝对必要性。
