title: Virological outcome among HIV-1 infected patients on first-line antiretroviral treatment in semi-rural HIV clinics in Togo.
abstract: BACKGROUND
  Access to antiretroviral treatment (ART) in resource-limited countries has increased significantly but scaling-up ART into semi-rural and rural areas is more recent. Information on treatment outcome in such areas is still very limited notably due to additional difficulties to manage ART in these areas.
  
  
  RESULTS
  387 HIV-1 infected adults (≥18 years) were consecutively enrolled when attending healthcare services for their routine medical visit at 12 or 24 months on first-line ART in five HIV care centers (four semi-rural and one rural). Among them, 102 patients were on first-line ART for 12 ± 2 months (M12) and 285 for 24 ± 2 months (M24). Virological failure was observed in 70 (18.1 %) patients ranging from 13.9 to 31.6 % at M12 and from 8.1 to 22.4 % at M24 across the different sites. For 67/70 patients, sequencing was successful and drug resistance mutations were observed in 65 (97 %). The global prevalence of drug resistance in the study population was thus at least 16.8 % (65/387). Moreover, 32 (8.3 %) and 27 (6.9 %) patients were either on a completely ineffective ART regime or with only a single drug active. Several patients accumulated high numbers of mutations and developed also cross-resistance to abacavir, didanosine or the new NNRTI drugs like etravirine and rilpivirine.
  
  
  CONCLUSIONS
  The observations on ART treatment outcome from ART clinics in semi-rural areas are close to previous observations in Lomé, the capital city suggesting that national ART-programme management plays a role in treatment outcome.
authors.affiliation: Laboratoire de Biologie Moléculaire et d'Immunologie (BIOLIM/FSS/UL), Université de Lomé, Lomé, Togo.
authors.forename: Abla A
authors.initials: AA
authors.lastname: Konou
authors.affiliation: Laboratoire de Biologie Moléculaire et d'Immunologie (BIOLIM/FSS/UL), Université de Lomé, Lomé, Togo ; Département des sciences fondamentales et biologiques, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.
authors.forename: Mounerou
authors.initials: M
authors.lastname: Salou
authors.affiliation: UMI 233, Institut de Recherche pour le Développement (IRD)/INSERM U1175, Université de Montpellier, Montpellier, France.
authors.forename: Nicole
authors.initials: N
authors.lastname: Vidal
authors.affiliation: Centre Médico-Social (CMS) Kouvé, Kouvé, Togo.
authors.forename: Pascal
authors.initials: P
authors.lastname: Kodah
authors.affiliation: Hopital Général d'Aného, Aného, Togo.
authors.forename: Damobé
authors.initials: D
authors.lastname: Kombate
authors.affiliation: Centre Hospitalier Préfectoral (CHP) Kpalimé, Kpalimé, Togo.
authors.forename: Pyabalo
authors.initials: P
authors.lastname: Kpanla
authors.affiliation: Centre Hospitalier Universitaire (CHU) Kara, Kara, Togo.
authors.forename: Tchabia
authors.initials: T
authors.lastname: Nabroulaba
authors.affiliation: Centre Hospitalier Régional (CHR) Atakpamé, Atakpamé, Togo.
authors.forename: Djifa
authors.initials: D
authors.lastname: Nyametso
authors.affiliation: Programme National de Lutte contre le Sida (PNLS), Lomé, Togo.
authors.forename: Assétina
authors.initials: A
authors.lastname: Singo-Tokofaï
authors.affiliation: Conseil National de Lutte contre le Sida (CNLS), Lomé, Togo.
authors.forename: Palokinam
authors.initials: P
authors.lastname: Pitche
authors.affiliation: UMI 233, Institut de Recherche pour le Développement (IRD)/INSERM U1175, Université de Montpellier, Montpellier, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Delaporte
authors.affiliation: Laboratoire de Biologie Moléculaire et d'Immunologie (BIOLIM/FSS/UL), Université de Lomé, Lomé, Togo ; Département des sciences fondamentales et biologiques, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.
authors.forename: Mireille
authors.initials: M
authors.lastname: Prince-David
authors.affiliation: UMI 233, Institut de Recherche pour le Développement (IRD)/INSERM U1175, Université de Montpellier, Montpellier, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Peeters
authors.affiliation: Laboratoire de Biologie Moléculaire et d'Immunologie (BIOLIM/FSS/UL), Université de Lomé, Lomé, Togo ; Département des sciences fondamentales et biologiques, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo ; 08 B.P. 8742, Lomé 08, Togo.
authors.forename: Anoumou Y
authors.initials: AY
authors.lastname: Dagnra
keywords: Africa; Antiretroviral treatment; Drug resistance; HIV; Public health; Semi-rural; Togo