title: Antiretroviral treatment outcome in HIV-1-infected patients routinely followed up in capital cities and remote areas of Senegal, Mali and Guinea-Conakry.
abstract: BACKGROUND
  Access to antiretroviral treatment (ART) becomes more and more effective in resource-limited settings (RLS). However, this global effort would be even more profitable if the access to laboratory services especially in decentralized settings was strengthened. We report the virological outcome and HIV-1 drug resistance in three West African countries using dried blood spots (DBS) samples.
  
  
  METHODS
  We included HIV-1-infected adults on ART ≥6 months and followed up in capital cities and decentralized sites in Senegal, Mali and Guinea-Conakry. Patients were consecutively enrolled and DBS were collected in field conditions and kept at ambient temperature before transfer to the reference laboratory. Viral load (VL) was quantified using the NucliSENS EasyQ HIV-1 v1.2. Genotyping of HIV-1 pol gene was performed using in-house protocol.
  
  
  RESULTS
  Of the 407 participants, 119, 152 and 136 were from Senegal, Mali and Guinea-Conakry, respectively. The median treatment duration was 36 months [IQR: 6-136]. Virological failure (VF) (VL≥3log10 copies/mL) was observed in 26% (95% confidence interval (CI), 18-35; n=31), 11% (95% CI, 6-17; n=16) and 24% (95% CI, 17-32; n=33) of patients in Senegal, Mali and Guinea-Conakry, respectively (p=0.001). Of samples presenting VL≥3log10 copies/mL (n=80), 70 were successfully genotyped. At least one drug resistance mutation (DRM) was detected in the following proportions: 70% (95% CI, 50-86; n=19), 93% (95% CI, 68-100; n=14) and 68% (95% CI, 48-84; n=19) in Senegal, Mali and Guinea-Conakry, respectively (p=0.22). Twenty-six per cent (26%; 95% CI, 16-38; n=18) of patients in VF harboured wild-type viruses, which is likely indicative of weak adherence. Phylogenetic analysis showed the predominance of CRF02_AG subtype (73%; 95% CI, 61-83; n=51).
  
  
  CONCLUSIONS
  We describe the ART outcome in capital and rural settings of Senegal, Mali and Guinea-Conakry. Our results in all of the three countries highlight the need to reinforce the ART adherence in order to minimize the occurrence of drug resistance. In addition, these findings provide additional evidence that the use of DBS as a sampling support could assist virological monitoring of patients on ART in remote areas.
authors.affiliation: Laboratoire de Bactériologie Virologie CHU Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal.
authors.forename: Abou Abdallah Malick
authors.initials: AA
authors.lastname: Diouara
authors.affiliation: Laboratoire de Bactériologie Virologie CHU Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal.
authors.forename: Halimatou Diop
authors.initials: HD
authors.lastname: Ndiaye
authors.affiliation: Service de Bactériologie-Virologie Institut, National de Recherche en Santé Publique (INRSP) de Bamako, Bamako, Mali.
authors.forename: Ibrehima
authors.initials: I
authors.lastname: Guindo
authors.affiliation: Service de Dermatologie CHU Donka, CTA, Conakry, République de Guinée.
authors.forename: Nestor
authors.initials: N
authors.lastname: Bangoura
authors.affiliation: Service de Dermatologie CHU Donka, CTA, Conakry, République de Guinée.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Cissé
authors.affiliation: Laboratoire de Bactériologie Virologie CHU Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal.
authors.forename: Tchiakpe
authors.initials: T
authors.lastname: Edmond
authors.affiliation: Service de Bactériologie-Virologie Institut, National de Recherche en Santé Publique (INRSP) de Bamako, Bamako, Mali.
authors.forename: Flabou
authors.initials: F
authors.lastname: Bougoudogo
authors.affiliation: Laboratoire de Bactériologie Virologie CHU Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal.
authors.forename: Souleymame
authors.initials: S
authors.lastname: Mboup
authors.affiliation: UMI 233 TransVIHMI, IRD and Université de Montpellier 1, Montpellier, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Peeters
authors.affiliation: UMI 233 TransVIHMI, IRD and Université de Montpellier 1, Montpellier, France.
authors.forename: Ahidjo
authors.initials: A
authors.lastname: Ayouba
authors.affiliation: Laboratoire de Bactériologie Virologie CHU Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal; ctourekane@yahoo.co.uk.
authors.forename: Ndèye Coumba Touré
authors.initials: NC
authors.lastname: Kane
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D016903:Drug Monitoring / Q000379:methods; D024882:Drug Resistance, Viral; D005260:Female; D005838:Genotype; D016701:Guinea; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D015497:HIV-1 / Q000235:genetics* / Q000302:isolation & purification; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008302:Mali; D008875:Middle Aged; D012424:Rural Population; D012675:Senegal; D016896:Treatment Outcome; D014505:Urban Population; D055815:Young Adult; D054302:pol Gene Products, Human Immunodeficiency Virus / Q000235:genetics
chemical_list: D044966:Anti-Retroviral Agents; D054302:pol Gene Products, Human Immunodeficiency Virus
keywords: HIV-1 drug resistance; HIV-1 genetic diversity; West Africa; dried blood spots; remote areas; viral load