title: HIV type 1 drug resistance in adults receiving highly active antiretroviral therapy in Abidjan, Côte d'Ivoire.
abstract: As antiretroviral therapy continues to scale-up in developing countries, there is concern that high levels of HIV drug resistance to antiretroviral drugs will occur. Here we describe rates of emergence of HIV-1 drug resistance and factors associated with their occurrence among adults who received antiretroviral therapy (ART) for >1 year through the Côte d'Ivoire national drug access program from 1998 to 2003. To detect genotypic drug resistance, we sequenced all 1- and 2-year specimens with detectable HIV RNA viral load. To assess factors associated with emerging drug resistance, we used log normal regression with interval censoring, including covariates in the model for self-reported drug adherence, CD4 cell count, and HIV viral load at therapy initiation, and observed changes in these measures, type of prescribed ART drugs, diagnoses of opportunistic illness, and demographic characteristics. An estimated 14.2% [95% confidence limits (CL) 11.7, 16.9] and 26.6% (95% CL 22.7, 30.8) of patients developed primary drug-resistant mutations within 1 year and 2 years after initiation of therapy, respectively. Factors associated with drug resistance included drug nonadherence, partial or lack of viral suppression, higher viral load or lower CD4 at initiation of therapy, and initiation of ART with what is now considered substandard dual combination therapy. Our results demonstrate the need to strengthen adherence and continuity in treatment programs in order to avoid interruption of ART drugs. Treatment programs should pay attention to indicators of emerging drug resistance: incomplete or lesser decreases in viral load or increases in CD4 cell counts following initiation of therapy, and the occurrence of AIDS opportunistic illnesses.
authors.affiliation: Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Hanson
authors.forename: Christiane
authors.initials: C
authors.lastname: Adjé-Touré
authors.forename: N
authors.initials: N
authors.lastname: Talla-Nzussouo
authors.forename: Pascal
authors.initials: P
authors.lastname: Eby
authors.forename: Marie-Yolande
authors.initials: MY
authors.lastname: Borget
authors.forename: Léonard Ya
authors.initials: LY
authors.lastname: Kouadio
authors.forename: Bile Ebi
authors.initials: BE
authors.lastname: Celestin
authors.forename: Odette
authors.initials: O
authors.lastname: Tossou
authors.forename: Serge
authors.initials: S
authors.lastname: Eholie
authors.forename: Auguste
authors.initials: A
authors.lastname: Kadio
authors.forename: Terence
authors.initials: T
authors.lastname: Chorba
authors.forename: John N
authors.initials: JN
authors.lastname: Nkengasong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019943:Amino Acid Substitution / Q000235:genetics; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D007560:Cote d'Ivoire; D024882:Drug Resistance, Viral; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D020125:Mutation, Missense; D015995:Prevalence; D012367:RNA, Viral / Q000235:genetics; D012307:Risk Factors; D017422:Sequence Analysis, DNA; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral