title: Monitoring HIV viral load in resource limited settings: still a matter of debate?
abstract: BACKGROUND
  Consequences of lack of viral monitoring in predicting the effects of development of HIV drug resistance mutations during HAART in resource-limited settings (RLS) is still a matter of debate.
  
  
  METHODS
  To assess, among HIV+ patients receiving their first-line HAART, prevalence of virological failure and genotypic resistance mutations pattern in a Médécins Sans Frontières/Ministry of Health programme in Busia District (Kenya).
  
  
  METHODS
  Patients with HAART treatment for ≥12 months were eligible for the study and those with HIV-RNA ≥5000 copies/ml underwent genotypic study. Total HIV-1 RNA from Dried Blood Spots was extracted using Nuclisens method.
  
  
  RESULTS
  926 patients were included. Among 274 (29.6%) patients with detectable viral load, 55 (5.9%) experienced treatment failure (viral load >5.000 copies/ml); 61.8% were female and 10 (18.2%) had clinical failure. Median CD4 cell count was 116 cell/mm3 (IQR: 54-189). Median HIV-RNA was 32,000 copies/ml (IQR: 11000-68000). Eighteen out of 55 (33%) samples could be sequenced on PR and RT genes, with resistance associated mutations (RAMs) in 15 out of 18 samples (83%). Among patients carrying RAMs, 12/15 (81%) harboured RAMs associated to thymidine analogues (TAMs). All of them (100%) showed M184V resistance associated mutation to lamivudine as well as NNRTI's RAMS.
  
  
  CONCLUSIONS
  Virological failure rate in resource-limited settings are similar to those observed in developed countries. Resistance mutation patterns were concordant with HAART received by failing patients. Long term detectable viral load confers greater probability of developing resistance and as a consequence, making difficult to find out a cost-effective subsequent treatment regimen.
authors.affiliation: Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Arnedo
authors.forename: Elena
authors.initials: E
authors.lastname: Alonso
authors.forename: Nell
authors.initials: N
authors.lastname: Eisenberg
authors.forename: Laura
authors.initials: L
authors.lastname: Ibáñez
authors.forename: Cecilia
authors.initials: C
authors.lastname: Ferreyra
authors.forename: Angels
authors.initials: A
authors.lastname: Jaén
authors.forename: Laurence
authors.initials: L
authors.lastname: Flevaud
authors.forename: Samuel
authors.initials: S
authors.lastname: Khamadi
authors.forename: Paul
authors.initials: P
authors.lastname: Roddy
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Gatell
authors.forename: David
authors.initials: D
authors.lastname: Dalmau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D006679:HIV Seropositivity / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D007630:Kenya; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents