Boullé Charlotte, Guichet Emilande, Kouanfack Charles, Aghokeng Avelin, Onambany Benjamin, Ikaka Catherine Massama, Ngock Emile, Tsoumsta Landry, Msellati Philippe, Mpoudi-Ngolé Eitel, Peeters Martine, Delaporte Eric, Laurent Christian
Institut de Recherche pour le Développement, Inserm, Université de Montpellier, Unité TransVIHMI , Montpellier , France.
Institut de Recherche pour le Développement, Inserm, Université de Montpellier, Unité TransVIHMI, Montpellier, France;; Centre de Recherche sur les Maladies Emergentes et Ré-émergentes,Yaoundé, Cameroon.
Open Forum Infect Dis. 2016 Dec 20;3(4):ofw233. doi: 10.1093/ofid/ofw233. eCollection 2016 Oct.
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.
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.
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.
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.
在非洲农村地区，抗逆转录病毒治疗（ART）的病毒学有效性数据不足以评估与联合国艾滋病规划署90-90-90治疗目标之间的差距。我们调查了喀麦隆农村地区接受常规治疗的患者中病毒载量未得到抑制的情况、抗逆转录病毒药物耐药性以及基因型耐药突变情况。
2013年至2014年在一家地区医院对年龄≥15岁且接受一线抗逆转录病毒治疗≥6个月的患者进行了一项横断面研究。为患者提供免费的人类免疫缺陷病毒病毒载量检测。当病毒载量>1000拷贝/mL时进行基因型耐药检测。使用多变量逻辑回归模型评估病毒载量未得到抑制或抗逆转录病毒药物耐药性与社会人口统计学和医学特征之间的关系。
在407例患者中（女性占74.9%，中位年龄41.8岁，抗逆转录病毒治疗的中位时间为29.2个月），96例（23.6%；95%置信区间[CI]，19.5 - 28.0）病毒载量未得到抑制，74例（18.2%；95%CI，14.6 - 22.3）存在抗逆转录病毒药物耐药性。病毒载量未得到抑制和耐药的发生率随抗逆转录病毒治疗时间的延长而增加，在6至12个月组中分别为12.0%和8.0%，在>72个月组中分别为31.3%和27.1%。所有74例有抗逆转录病毒药物耐药性的患者均对非核苷类逆转录酶抑制剂耐药，其中57例还对核苷类逆转录酶抑制剂耐药。
我们的估计是在西非和中非地区观察到的最高值之一。病毒学失败患者的比例应至少减半才能达到联合国艾滋病规划署90-90-90治疗目标。
