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. 2016 Dec 20;3(4):ofw233.
doi: 10.1093/ofid/ofw233. eCollection 2016 Oct.

Virologic Failure and Human Immunodeficiency Virus Drug Resistance in Rural Cameroon With Regard to the UNAIDS 90-90-90 Treatment Targets

Charlotte Boullé  1 , Emilande Guichet  2 , Charles Kouanfack  3 , Avelin Aghokeng  2 , Benjamin Onambany  4 , Catherine Massama Ikaka  4 , Emile Ngock  4 , Landry Tsoumsta  5 , Philippe Msellati  1 , Eitel Mpoudi-Ngolé  5 , Martine Peeters  1 , Eric Delaporte  1 , Christian Laurent  1
Affiliations

Virologic Failure and Human Immunodeficiency Virus Drug Resistance in Rural Cameroon With Regard to the UNAIDS 90-90-90 Treatment Targets

Charlotte Boullé et al. Open Forum Infect Dis. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Africa; antiretroviral; resistance; treatment; virologic failure.

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Figures

Figure 1.
Figure 1.
Study flowchart. ART, antiretroviral therapy.
Figure 2.
Figure 2.
Antiretroviral regimen at treatment initiation and at the time of the study. d4T, stavudine; EFV, efavirenz; NVP, nevirapine; TDF, tenofovir disoproxil fumarate; ZDV, zidovudine; 3TC, lamivudine.
Figure 3.
Figure 3.
Genotypic nucleoside reverse-transcriptase inhibitor (NRTI) and non-NRTI-associated resistance mutations.
See this image and copyright information in PMC

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