title: High efficacy of first-line ART in a West African cohort, assessed by dried blood spot virological and pharmacological measurements.
abstract: The objectives of this study were to determine the rate of viral success in HIV-infected patients on first-line ART by the assessment of dried blood spot (DBS) viral load (VL) and to assess the performance of DBS sampling for VL measurement, genotypic resistance and antiretroviral concentration determinations.
  
  
  
  HIV-infected patients treated for >1 year with first-line ART in Niamey, Niger were included. VL based on nucleic acid sequence-based amplification (NASBA) assay (limit of quantification <800 copies/mL) was measured on DBS capillary samples. Resistance genotype was assessed for all detectable VLs (limit of detection >100 copies/mL); antiretroviral concentrations were interpreted using standard plasma cut-offs after extrapolation of blood to plasma results. Median (IQR) results are presented.
  
  
  
  Two hundred and eighteen patients (61% women), aged 41 (34-46) years, with 138 (56-235) CD4 cells/mm3at baseline were included. After 4 (2-6) years of follow-up under therapy, CD4 gain was +197 (98-372) cells/mm3; 81% had VL <800 copies/mL. Antiretroviral concentrations were adequate in 87% of patients and nevirapine/efavirenz concentrations were related to viral success (P < 0.001). DBS genotypic resistance amplification succeeded in 71% of failing patients: NRTI drug resistance mutations were identified in 73% including resistance to lamivudine/emtricitabine (67%), abacavir (30%) and tenofovir (21%); and NNRTI drug resistance mutations were identified in 82% including resistance to rilpivirine (39%) and etravirine (15%).
  
  
  
  This study demonstrated a good response after 4 years of first-line ART in Niger. Adherence was high, according to antiretroviral concentrations, and the majority of failures were explained by selection of drug resistance mutations detected in the DBS genotype. Using DBS might improve the assessment of ART failure in HIV-infected patients in low-income countries.
authors.affiliation: Hôpitaux Universitaires Paris IdF-Ouest, APHP, France p.de-truchis@aphp.fr.|GIP-ESTHER, Expertise France, Paris, France.|Entraide Sante 92, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: de Truchis
authors.affiliation: Pharmaco-Toxicology Department, Hôpital Bichat - Claude Bernard, APHP, INSERM IAME UMR 1137, Paris, France.
authors.forename: Minh Patrick
authors.initials: MP
authors.lastname: Lê
authors.affiliation: GIP-ESTHER, Expertise France, Paris, France.|Hôpital National de Niamey, Niger.
authors.forename: Mamane
authors.initials: M
authors.lastname: Daou
authors.affiliation: GIP-ESTHER, Expertise France, Paris, France.|Hôpital National de Niamey, Niger.
authors.forename: Boubacar
authors.initials: B
authors.lastname: Madougou
authors.affiliation: Centre de Traitement Ambulatoire, CTA, Niamey, Niger.
authors.forename: Yacouba
authors.initials: Y
authors.lastname: Nouhou
authors.affiliation: Hôpital National de Niamey, Niger.
authors.forename: Sahada
authors.initials: S
authors.lastname: Moussa Saley
authors.affiliation: Hôpital National de Niamey, Niger.
authors.forename: Achirou
authors.initials: A
authors.lastname: Sani
authors.affiliation: Hôpital National de Niamey, Niger.
authors.forename: Eric
authors.initials: E
authors.lastname: Adehossi
authors.affiliation: Hôpitaux Universitaires Paris IdF-Ouest, APHP, France.|GIP-ESTHER, Expertise France, Paris, France.|Entraide Sante 92, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Rouveix
authors.affiliation: Laboratoire National de Virologie, CHU Lamordé, Niamey, Niger.
authors.forename: Mamadou
authors.initials: M
authors.lastname: Saidou
authors.affiliation: Pharmaco-Toxicology Department, Hôpital Bichat - Claude Bernard, APHP, INSERM IAME UMR 1137, Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Peytavin
authors.affiliation: Laboratoire de Virologie-INSERM U941, Hôpital Saint Louis-APHP, Université Paris Diderot, Paris, France.
authors.forename: Constance
authors.initials: C
authors.lastname: Delaugerre
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001769:Blood / Q000821:virology*; D001774:Blood Chemical Analysis; D003430:Cross-Sectional Studies; D003890:Desiccation; D005260:Female; D060005:Genotyping Techniques / Q000379:methods; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008826:Microbial Sensitivity Tests / Q000379:methods; D008875:Middle Aged; D009548:Niger; D021141:Nucleic Acid Amplification Techniques / Q000379:methods; D013048:Specimen Handling / Q000379:methods*; D016896:Treatment Outcome; D019562:Viral Load / Q000379:methods*; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents