With ongoing earlier enrollment on and rapid scale-up of antiretroviral therapy (ART) in Cameroon, there are increasing risks of transmitted HIV drug resistance (HIVDR) at population levels. We therefore evaluated the threshold of HIVDR in a population initiating ART, in order to inform on the effectiveness of first-line regimens, considering HIV-1 diversity, plasma viral load (PVL) and CD4-based disease progression. A total of 53 adults (median [Interquartile range, IQR] CD4: 162 cell/mm3 [48-284]; median [IQR] PVL: 5.34 log10 RNA [4.17-6.42] copies/ml) initiating ART in 2014 at the Yaoundé Central Hospital were enrolled for HIV-1 protease-reverse transcriptase sequencing. Drug resistance mutations (DRMs) were interpreted using the 2009 World Health Organization (WHO) list versus the Stanford HIVdb algorithm version 7.0. Level of DRMs was low (3.77%) versus moderate (7.55%) respectively following the WHO list (T69D, K103N) versus Stanford HIVdb (T69D, A98G, K103N, K238T), respectively. Prevailing clade was CRF02_AG (71.70%). Based on Stanford HIVdb, a slightly higher proportion of patients with DRMs was found among ones infected with CRF02_AG than in those non-CRF02_AG infected (7.89% versus 6.67%, p=1.000), with lower-PVL (7.69% <5.5 versus 0% ≥5.5 log10 RNA copies/ml, p=0.488) and with higher-CD4 counts (9.52% CD4 ≥200 versus 3.33% CD4 <200 cells/mm3, p=0.749). Thresholds of DRMs suggest that standard first-line regimens currently used in Cameroon may remain effective at population levels, despite scale-up of ART in the country, pending adherence and closed virological monitoring. With an intent-to-diagnose approach, the discrepant levels of DRMs support using Stanford HIVdb to evaluate initial ART, while revising the WHO list for surveillance.

Fokam, J., Takou, D., Santoro, M., Akonie, H., Kouanfack, C., CECCHERINI SILBERSTEIN, F., et al. (2016). Short communication: Population-based surveillance of HIV-1 drug resistance in cameroonian adults initiating antiretroviral therapy according to the world health organization guidelines. AIDS RESEARCH AND HUMAN RETROVIRUSES, 32(4), 329-333 [10.1089/AID.2015.0065].

Short communication: Population-based surveillance of HIV-1 drug resistance in cameroonian adults initiating antiretroviral therapy according to the world health organization guidelines

Santoro, MM;CECCHERINI SILBERSTEIN, FRANCESCA;COLIZZI, VITTORIO;PERNO, CARLO FEDERICO;
2016-01-01

Abstract

With ongoing earlier enrollment on and rapid scale-up of antiretroviral therapy (ART) in Cameroon, there are increasing risks of transmitted HIV drug resistance (HIVDR) at population levels. We therefore evaluated the threshold of HIVDR in a population initiating ART, in order to inform on the effectiveness of first-line regimens, considering HIV-1 diversity, plasma viral load (PVL) and CD4-based disease progression. A total of 53 adults (median [Interquartile range, IQR] CD4: 162 cell/mm3 [48-284]; median [IQR] PVL: 5.34 log10 RNA [4.17-6.42] copies/ml) initiating ART in 2014 at the Yaoundé Central Hospital were enrolled for HIV-1 protease-reverse transcriptase sequencing. Drug resistance mutations (DRMs) were interpreted using the 2009 World Health Organization (WHO) list versus the Stanford HIVdb algorithm version 7.0. Level of DRMs was low (3.77%) versus moderate (7.55%) respectively following the WHO list (T69D, K103N) versus Stanford HIVdb (T69D, A98G, K103N, K238T), respectively. Prevailing clade was CRF02_AG (71.70%). Based on Stanford HIVdb, a slightly higher proportion of patients with DRMs was found among ones infected with CRF02_AG than in those non-CRF02_AG infected (7.89% versus 6.67%, p=1.000), with lower-PVL (7.69% <5.5 versus 0% ≥5.5 log10 RNA copies/ml, p=0.488) and with higher-CD4 counts (9.52% CD4 ≥200 versus 3.33% CD4 <200 cells/mm3, p=0.749). Thresholds of DRMs suggest that standard first-line regimens currently used in Cameroon may remain effective at population levels, despite scale-up of ART in the country, pending adherence and closed virological monitoring. With an intent-to-diagnose approach, the discrepant levels of DRMs support using Stanford HIVdb to evaluate initial ART, while revising the WHO list for surveillance.
2016
Pubblicato
Rilevanza internazionale
Articolo
Sì, ma tipo non specificato
Settore MED/07 - Microbiologia e Microbiologia Clinica
English
Con Impact Factor ISI
Surveillance, HIV drug resistance, first-line regimen, Cameroon, subtype.
Fokam, J., Takou, D., Santoro, M., Akonie, H., Kouanfack, C., CECCHERINI SILBERSTEIN, F., et al. (2016). Short communication: Population-based surveillance of HIV-1 drug resistance in cameroonian adults initiating antiretroviral therapy according to the world health organization guidelines. AIDS RESEARCH AND HUMAN RETROVIRUSES, 32(4), 329-333 [10.1089/AID.2015.0065].
Fokam, J; Takou, D; Santoro, M; Akonie, H; Kouanfack, C; CECCHERINI SILBERSTEIN, F; Colizzi, V; Perno, Cf; Ndjolo, A
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/133873
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