title: 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.
abstract: 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. Although 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 nonnucleoside reverse transcriptase inhibitor or indinavir, a first-generation nonboosted protease inhibitor, followed for >6 months and having >1 viral load (VL) measurement were included. Virological failure was defined as 2 consecutive VL measurements >1000 copies/mL.
  
  
  RESULTS
  Of the 366 patients included, 89% achieved a VL <500 copies/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 protease inhibitor-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. Although 81% of the 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 with those from high-resource settings. However, the rate of virological failure for second-line treatment was high, probably because of accumulation of resistances.
authors.affiliation: *UMI 233, Institut de Recherche pour le Développement (IRD), Université de Montpellier 1, Montpellier, France †Laboratoire de Bactériologie-Virologie, Hôpital Le Dantec, Dakar, Sénégal ‡Multisectorial AIDS Program, Dakar, Senegal §Centre Régional de Recherche et Formation sur le VIH/SIDA, Université Cheikh Anta Diop (UCAD), UMI 233, Dakar, Sénégal ‖Centre de traitement ambulatoire, CHU de Fann, Dakar, Sénégal.
authors.forename: Pierre
authors.initials: P
authors.lastname: De Beaudrap
authors.forename: Moussa
authors.initials: M
authors.lastname: Thiam
authors.forename: Assane
authors.initials: A
authors.lastname: Diouf
authors.forename: Coumba
authors.initials: C
authors.lastname: Toure-Kane
authors.forename: Ndèye F
authors.initials: NF
authors.lastname: Ngom-Guèye
authors.forename: Nicole
authors.initials: N
authors.lastname: Vidal
authors.forename: Souleymane
authors.initials: S
authors.lastname: Mboup
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Ndoye
authors.forename: Papa S
authors.initials: PS
authors.lastname: Sow
authors.forename: Eric
authors.initials: E
authors.lastname: Delaporte
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008297:Male; D012675:Senegal; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents