Document Detail


Risk of virological failure and drug resistance during first and second-line antiretroviral therapy in a 10-year cohort in Senegal: results from the ANRS 1215 cohort.
MedLine Citation:
PMID:  23117504     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: In 1998, Senegal launched one of Africa's first antiretroviral therapy (ART) programs. Since then, the number of treated patients in Africa has substantially increased thanks to simplification in treatment management. While good outcomes over the first years of ART have been observed in sub-Saharan Africa, little is known about the long-term (>5 years) risks of virological failure and drug resistance and about second-line treatment response. METHODS:: Patients from the ANRS-1215 cohort in Senegal, started with either one non-nucleoside reverse transcriptase inhibitor (NNRTI) or indinavir, a first-generation non-boosted protease inhibitor (PI), followed for > 6 months and having >1 viral load (VL) measurement were included. Virological failure was defined as two consecutive VL measurements >1000 cp/mL. RESULTS:: Of the 366 patients included, 89% achieved a VL<500 cp/mL. The risk of virological failure at 12, 24, and 60 months was 5, 16 and 25%, being higher in younger patients (p=0.05), those receiving a PI-containing regimen (p=0.05) and those with lower adherence (p=0.03). The risk of resistance to any drug at 12, 24, and 60 months was 3, 11 and 18%. After virological failure, 60% of the patients were switched to second-line treatments. While 81% of them patients achieved virological success, the risk of virological failure was 27% at 24 months, mostly in patients with multiple resistances. CONCLUSIONS:: In this cohort, virological outcomes for first-line treatments were good compared to those from high-resource settings. However, the rate of virological failure for second-line treatment was high, probably because of accumulation of resistances.
Authors:
Pierre De Beaudrap; Moussa Thiam; Assane Diouf; Coumba Toure-Kane; Ndèye F Ngom-Guèye; Nicole Vidal; Souleymane Mboup; Ibrahim Ndoye; Papa S Sow; Eric Delaporte;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-31
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  -     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-11-2     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1UMI 233, Institut de Recherche pour le Développement (IRD), Université de Montpellier 1, Montpellier, France. 2Laboratoire de Bactériologie-Virologie, Hôpital Le Dantec, Dakar, Sénégal. 3Multisectorial AIDS Program, Dakar, Senegal. 4Centre Régional de Recherche et Formation sur le VIH/SIDA, Université Cheikh Anta Diop (UCAD), UMI 233, Dakar, Sénégal 5Centre de traitement ambulatoire, CHU de Fann, Dakar, Sénégal.
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