title: Short Communication: High Viral Load and Multidrug Resistance Due to Late Switch to Second-Line Regimens Could Be a Major Obstacle to Reach the 90-90-90 UNAIDS Objectives in Sub-Saharan Africa.
abstract: In the context of lifelong antiretroviral treatment (ART) as early as possible and to end the HIV/AIDS epidemic as a public health treat by 2030, it is important to evaluate the potential risk of transmission of HIV-1 drug resistance (HIVDR) in resource-limited countries (RLCs). Since HIV transmission is driven by HIV-1 RNA viral load (VL), we studied the association between plasma VL and HIVDR profiles in 451 adults failing first-line ART from the 2LADY-ANRS12169/EDCTP trial in Burkina Faso, Cameroon, and Senegal. Median duration on first-line ART was 49 months (IQR: 33-69) and 91% patients were asymptomatic. Genotypic drug resistance testing was successful for 446 patients and 98.7% of them were resistant to at least one of the first-line drugs; 40.6% and 55.8% were resistant to two or three drugs of their ongoing first-line ART, respectively. The median VL was higher in patients with HIVDR to all ongoing first-line drugs than in those still susceptible to at least one drug; 4.7 log10copies/ml (IQR: 4.3-5.2) versus 4.2 log10copies/ml (IQR: 3.7-4.7), respectively (p < .001). The proportion of patients with HIVDR to all ongoing first-line drugs was highest (77.9% [95/122]) in patients with VL >5.0 log10copies/ml. High rates of cross-resistance to other nucleoside reverse-transcriptase inhibitors were observed and were also highest in patients with high VL. Without improvement of patient monitoring to avoid late switch to second-line regimens, a potential new epidemic caused by HIVDR strains could emerge in sub-Saharan Africa and compromise all efforts to reach 90-90-90 UNAIDS objective by 2020.
authors.affiliation: 1 UMI233-TransVIHMI, Institut de Recherche pour le Développement (IRD), INSERM U1175, Université de Montpellier , Montpellier, France .
authors.forename: Emilande
authors.initials: E
authors.lastname: Guichet
authors.affiliation: 1 UMI233-TransVIHMI, Institut de Recherche pour le Développement (IRD), INSERM U1175, Université de Montpellier , Montpellier, France .|2 Centre de Recherche sur les Maladies Emergentes et Réémergentes (CREMER) , Virology Laboratory IMPM-IRD, Yaoundé, Cameroon .
authors.forename: Avelin
authors.initials: A
authors.lastname: Aghokeng
authors.affiliation: 1 UMI233-TransVIHMI, Institut de Recherche pour le Développement (IRD), INSERM U1175, Université de Montpellier , Montpellier, France .
authors.forename: Laetitia
authors.initials: L
authors.lastname: Serrano
authors.affiliation: 3 Day Care Unit, University Hospital Souro Sanou , Bobo-Dioulasso, Burkina Faso .
authors.forename: Guillaume
authors.initials: G
authors.lastname: Bado
authors.affiliation: 4 Laboratory de Bacteriology-Virology, University Cheikh Anta Diop of Dakar , Dakar, Senegal .
authors.forename: Coumba
authors.initials: C
authors.lastname: Toure-Kane
authors.affiliation: 1 UMI233-TransVIHMI, Institut de Recherche pour le Développement (IRD), INSERM U1175, Université de Montpellier , Montpellier, France .
authors.forename: Sabrina
authors.initials: S
authors.lastname: Eymard-Duvernay
authors.affiliation: 1 UMI233-TransVIHMI, Institut de Recherche pour le Développement (IRD), INSERM U1175, Université de Montpellier , Montpellier, France .|5 Institut de Biologie Computationnelle (IBC), LIRMM, Université de Montpellier , Montpellier, France .
authors.forename: Christian-Julian
authors.initials: CJ
authors.lastname: Villabona-Arenas
authors.affiliation: 1 UMI233-TransVIHMI, 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: 1 UMI233-TransVIHMI, Institut de Recherche pour le Développement (IRD), INSERM U1175, Université de Montpellier , Montpellier, France .
authors.forename: Laura
authors.initials: L
authors.lastname: Ciaffi
authors.affiliation: 1 UMI233-TransVIHMI, Institut de Recherche pour le Développement (IRD), INSERM U1175, Université de Montpellier , Montpellier, France .
authors.forename: Martine
authors.initials: M
authors.lastname: Peeters
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002050:Burkina Faso / Q000453:epidemiology; D002163:Cameroon / Q000453:epidemiology; D024921:Drug Resistance, Multiple, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology*; D006801:Humans; D008297:Male; D015995:Prevalence; D012675:Senegal / Q000453:epidemiology; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: Africa; HIV; antiretroviral therapy; drug resistance; viral load