title: Impact of genotypic drug resistance mutations on clinical and immunological outcomes in HIV-infected adults on HAART in West Africa.
abstract: OBJECTIVE
  To analyse the association between the presence of resistance mutations and treatment outcomes. The impact of HIV-1 drug resistance mutations in African adults on HAART has so far never been reported.
  
  
  METHODS
  In 2004 in Abidjan, Côte d'Ivoire, 106 adults on HAART had plasma viral load measurements. Patients with detectable viral loads had resistance genotypic tests. Patients were followed until 2006. Main outcomes were serious morbidity and immunological failure (CD4 cell count < 200 cells/microl).
  
  
  RESULTS
  At study entry, the median previous time on HAART was 37 months and the median CD4 cell count was 266 cells/microl; 58% of patients had undetectable viral loads, 20% had detectable viral loads with no major resistance mutations, and 22% had detectable viral loads with one or more major mutations. The median change in CD4 cell count between study entry and study termination was +129 cells/microl in patients with undetectable viral loads, +51 cells/microl in those with detectable viral loads with no mutations and +3 cells/microl in those with detectable viral loads with resistance mutations. Compared with patients with undetectable viral loads, those with detectable viral loads with resistance mutations had adjusted hazard ratios of immunological failure of 4.32 (95%CI 1.38-13.57, P = 0.01). One patient died. The 18-month probability of remaining free of morbidity was 0.79 in patients with undetectable viral loads and 0.69 in those with resistance mutations (P = 0.19).
  
  
  CONCLUSIONS
  In this setting with restricted access to second-line HAART, patients with major resistance mutations had higher rates of immunological failure, but most maintained stable CD4 cell counts and stayed alive for at least 20 months.
authors.affiliation: INSERM U593, Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076 Bordeaux, France. catherine.seyler@club-internet.fr
authors.forename: Catherine
authors.initials: C
authors.lastname: Seyler
authors.forename: Christiane
authors.initials: C
authors.lastname: Adjé-Touré
authors.forename: Eugène
authors.initials: E
authors.lastname: Messou
authors.forename: Nicole
authors.initials: N
authors.lastname: Dakoury-Dogbo
authors.forename: François
authors.initials: F
authors.lastname: Rouet
authors.forename: Delphine
authors.initials: D
authors.lastname: Gabillard
authors.forename: Monica
authors.initials: M
authors.lastname: Nolan
authors.forename: Siaka
authors.initials: S
authors.lastname: Toure
authors.forename: Xavier
authors.initials: X
authors.lastname: Anglaret
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count / Q000379:methods; D015331:Cohort Studies; D007560:Cote d'Ivoire / Q000453:epidemiology; D024882:Drug Resistance, Viral / Q000235:genetics; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy* / Q000235:genetics / Q000276:immunology; D015497:HIV-1 / Q000235:genetics; D015498:HIV-2 / Q000235:genetics; D006801:Humans; D008297:Male; D009154:Mutation; D016896:Treatment Outcome; D019562:Viral Load / Q000379:methods