Ngo-Malabo Elodie Teclaire, Ngoupo Paul Alain, Sadeuh-Mba Serge Alain, Akongnwi Emmanuel, Banaï Robert, Ngono Laure, Bilong-Bilong Charles Felix, Kfutwah Anfumbom, Njouom Richard
Virology department, Centre Pasteur of Cameroon, Yaounde. Cameroon.
Laboratory of Parasitology and Ecology, University of Yaounde I Faculty of Science, Yaounde. Cameroon.
Curr HIV Res. 2017;15(4):297-305. doi: 10.2174/1570162X15666170725143835.
First line antiretroviral therapy in a resource-limited setting consists of nucleotide and non-nucleotide reverse transcriptase inhibitors. Protease inhibitors are the hub of second line therapy. The decision to change antiretroviral therapy for a patient is frequently presumptive because of the lack of genotypic resistance tests in routine follow-up. We describe here the resistance profiles observed in patients with varying terms of antiretroviral therapy in Cameroon after implementation of HIV genotypic resistance testing in routine practice.
HIV genotypic resistance testing was carried out on consecutive samples received between August 2013 and November 2015. Protease (Prot) and reverse transcriptase (Rt) genes of the HIV genome were amplified, sequenced and analyzed for drug resistance mutations following the algorithm set up by the French National Agency for research on HIV/AIDS and viral hepatitis.
Specimens from a total of 167 patients infected with non-B HIV subtypes were received during the study period. Overall 61.7% patients had viral loads of more than 3log copies/ml, suggesting treatment failure. Among the 72 patients on first line, 56 (77.8%) were resistant to Lamivudine, 57 (79.1%) to Efavirenz and 58 (80.6%) to Nevirapine. Overall, more patients (75.0%) on first line antiretroviral therapy harbored multi-drug resistance compared to their counterparts on second line (25.8%).
This study revealed that a group of patients with antiretroviral therapy failure harbored multi-drug resistance mutations related to the majority of drugs in the first line regimen. Therefore, HIV resistance testing could be a useful tool to improve HIV care in resource limited settings like Cameroon where treatment options are limited.
在资源有限的环境中，一线抗逆转录病毒疗法由核苷酸和非核苷酸逆转录酶抑制剂组成。蛋白酶抑制剂是二线治疗的核心。由于在常规随访中缺乏基因型耐药性检测，为患者更换抗逆转录病毒疗法的决定往往是推测性的。我们在此描述了在喀麦隆将HIV基因型耐药性检测纳入常规实践后，不同抗逆转录病毒治疗疗程的患者中观察到的耐药谱。
对2013年8月至2015年11月期间连续收到的样本进行HIV基因型耐药性检测。按照法国国家艾滋病和病毒性肝炎研究机构制定的算法，对HIV基因组的蛋白酶（Prot）和逆转录酶（Rt）基因进行扩增、测序并分析耐药性突变。
在研究期间共收到167例感染非B型HIV亚型患者的样本。总体而言，61.7%的患者病毒载量超过3log拷贝/ml，提示治疗失败。在72例接受一线治疗的患者中，56例（77.8%）对拉米夫定耐药，57例（79.1%）对依非韦伦耐药，58例（80.6%）对奈韦拉平耐药。总体而言，与二线治疗患者（25.8%）相比，一线抗逆转录病毒治疗患者中更多患者（75.0%）存在多药耐药。
本研究表明，一组抗逆转录病毒治疗失败的患者存在与一线治疗方案中大多数药物相关的多药耐药突变。因此，在喀麦隆这样治疗选择有限的资源有限环境中，HIV耐药性检测可能是改善HIV治疗的有用工具。
