title: Prevalence of HIV-1 drug resistance among patients failing first-line ART in Monrovia, Liberia: a cross-sectional study.
abstract: OBJECTIVE
  To assess the prevalence of acquired drug resistance in HIV-1-infected patients living in Monrovia, Liberia, who had clinical and/or immunological failure of first-line ART according to WHO criteria.
  
  
  METHODS
  Patients receiving ART for >1 year with clinical and/or immunological failure were included. Sequencing of protease and reverse transcriptase regions was performed using Agence Nationale de Recherche sur le SIDA et les hépatites virales (ANRS) procedures and sequences were interpreted using the ANRS resistance algorithm.
  
  
  RESULTS
  Ninety patients were enrolled. They had been receiving ART for a median time of 42 months and half were receiving zidovudine/lamivudine/nevirapine. Seventy-five per cent of patients were infected with CRF02_AG. Twenty-seven per cent of patients displayed a plasma viral load <50 copies/mL. Among the 66 patients with detectable viraemia, the median viral load was 4.7 log10 copies/mL (IQR = 3.0-5.6). The prevalence of NRTI and NNRTI resistance-associated mutations (RAMs) was 63% and 71%, respectively; and the median number of NRTI and NNRTI RAMs was 2 and 3, respectively. Two patients (4%) displayed viruses with PI RAMs. Regarding NRTI drug resistance, 29%, 38%, 63%, 29% and 25% of patients had viruses resistant to zidovudine, stavudine, lamivudine/emtricitabine, abacavir and tenofovir, respectively. Regarding the NNRTI drug class, 56%, 65%, 33% and 42% of patients had viruses resistant to efavirenz, nevirapine, etravirine and rilpivirine, respectively.
  
  
  CONCLUSIONS
  The high prevalence of acquired drug resistance in patients followed in two centres of the Liberian capital city, documented after a median of 3 years on a first-line ART regimen, jeopardizes the activity of second-line regimens and highlights the need for virological monitoring in these settings.
authors.affiliation: Ensemble pour une Solidarité Thérapeutique en Réseau (GIP-ESTHER), Paris, France INSERM, IAME, UMR 1137, F-75018 Paris, France AP-HP, Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et Tropicales, F-75018 Paris, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Loubet
authors.affiliation: INSERM, IAME, UMR 1137, F-75018 Paris, France Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Virologie, F-75018 Paris, France charlotte.charpentier@bch.aphp.fr.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Charpentier
authors.affiliation: INSERM, IAME, UMR 1137, F-75018 Paris, France Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Virologie, F-75018 Paris, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Visseaux
authors.affiliation: John F. Kennedy Medical Center, Infectious Diseases Clinic, Monrovia, Liberia.
authors.forename: Abraham
authors.initials: A
authors.lastname: Borbor
authors.affiliation: John F. Kennedy Medical Center, Infectious Diseases Clinic, Monrovia, Liberia.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Nuta
authors.affiliation: John F. Kennedy Medical Center, Infectious Diseases Clinic, Monrovia, Liberia.
authors.forename: Eric
authors.initials: E
authors.lastname: Adu
authors.affiliation: Centre Hospitalo-Universitaire de Rennes, Service de Maladies Infectieuses et Tropicales, Rennes, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Chapplain
authors.affiliation: Redemption Hospital, Infectious Diseases Clinic, Monrovia, Liberia.
authors.forename: Maima
authors.initials: M
authors.lastname: Baysah
authors.affiliation: Centre Hospitalo-Universitaire de Rennes, Service de Maladies Infectieuses et Tropicales, Rennes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Tattevin
authors.affiliation: INSERM, IAME, UMR 1137, F-75018 Paris, France AP-HP, Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et Tropicales, F-75018 Paris, France Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France.
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
authors.affiliation: INSERM, IAME, UMR 1137, F-75018 Paris, France Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Virologie, F-75018 Paris, France.
authors.forename: Diane
authors.initials: D
authors.lastname: Descamps
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000494:pharmacology* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D003430:Cross-Sectional Studies; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology*; D016333:HIV Protease / Q000235:genetics; D054303:HIV Reverse Transcriptase / Q000235:genetics; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D007988:Liberia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D017422:Sequence Analysis, DNA; D017211:Treatment Failure
chemical_list: D044966:Anti-Retroviral Agents; C514824:reverse transcriptase, Human immunodeficiency virus 1; D054303:HIV Reverse Transcriptase; D016333:HIV Protease; C514803:p16 protease, Human immunodeficiency virus 1
keywords: HIV; acquired drug resistance; first-line regimen