title: Virologic Failure and Human Immunodeficiency Virus Drug Resistance in Rural Cameroon With Regard to the UNAIDS 90-90-90 Treatment Targets.
abstract: BACKGROUND
  In rural Africa, data on virologic effectiveness of antiretroviral treatment (ART) are not sufficient to assess the gap with the UNAIDS 90-90-90 treatment targets. We investigated the prevalences of unsuppressed viral load and antiretroviral drug resistance and the profile of genotypic resistance mutations among patients routinely treated in rural Cameroon.
  
  
  METHODS
  A cross-sectional study was performed in 2013-2014 among patients ≥15 years and on first-line ART for ≥6 months in a district hospital. Patients were offered free access to human immunodeficiency virus viral load testing. Genotypic drug resistance testing was done when the viral load was >1000 copies/mL. Multivariate logistic regression models were used to assess the relationship of unsuppressed viral load or antiretroviral drug resistance with sociodemographic and medical characteristics.
  
  
  RESULTS
  Of 407 patients (women 74.9%, median age 41.8 years, median time on ART 29.2 months), 96 (23.6%; 95% confidence interval [CI], 19.5-28.0) had unsuppressed viral load and 74 (18.2%; 95% CI, 14.6-22.3) had antiretroviral drug resistance. The prevalences of unsuppressed viral load and resistance increased with time on ART, from 12.0% and 8.0% in the 6- to 12-month group to 31.3% and 27.1% in the >72-month group, respectively. All 74 patients with antiretroviral drug resistance were resistant to nonnucleoside reverse-transcriptase inhibitors, and 57 of them were also resistant to nucleoside reverse-transcriptase inhibitors.
  
  
  CONCLUSIONS
  Our estimations were among the highest observed in the west and central African region. The proportion of patients with virologic failure should be divided at least by 2 to reach the UNAIDS 90-90-90 treatment targets.
authors.affiliation: Institut de Recherche pour le Développement, Inserm, Université de Montpellier, Unité TransVIHMI , Montpellier , France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Boullé
authors.affiliation: Institut de Recherche pour le Développement, Inserm, Université de Montpellier, Unité TransVIHMI, Montpellier, France;; Centre de Recherche sur les Maladies Emergentes et Ré-émergentes,Yaoundé, Cameroon.
authors.forename: Emilande
authors.initials: E
authors.lastname: Guichet
authors.affiliation: Central Hospital , Yaoundé, Cameroon.
authors.forename: Charles
authors.initials: C
authors.lastname: Kouanfack
authors.affiliation: Institut de Recherche pour le Développement, Inserm, Université de Montpellier, Unité TransVIHMI, Montpellier, France;; Centre de Recherche sur les Maladies Emergentes et Ré-émergentes,Yaoundé, Cameroon.
authors.forename: Avelin
authors.initials: A
authors.lastname: Aghokeng
authors.affiliation: District Hospital , Mfou, Cameroon.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Onambany
authors.affiliation: District Hospital , Mfou, Cameroon.
authors.forename: Catherine Massama
authors.initials: CM
authors.lastname: Ikaka
authors.affiliation: District Hospital , Mfou, Cameroon.
authors.forename: Emile
authors.initials: E
authors.lastname: Ngock
authors.affiliation: Centre de Recherche sur les Maladies Emergentes et Ré-émergentes, Yaoundé, Cameroon.
authors.forename: Landry
authors.initials: L
authors.lastname: Tsoumsta
authors.affiliation: Institut de Recherche pour le Développement, Inserm, Université de Montpellier, Unité TransVIHMI , Montpellier , France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Msellati
authors.affiliation: Centre de Recherche sur les Maladies Emergentes et Ré-émergentes, Yaoundé, Cameroon.
authors.forename: Eitel
authors.initials: E
authors.lastname: Mpoudi-Ngolé
authors.affiliation: Institut de Recherche pour le Développement, Inserm, Université de Montpellier, Unité TransVIHMI , Montpellier , France.
authors.forename: Martine
authors.initials: M
authors.lastname: Peeters
authors.affiliation: Institut de Recherche pour le Développement, Inserm, Université de Montpellier, Unité TransVIHMI , Montpellier , France.
authors.forename: Eric
authors.initials: E
authors.lastname: Delaporte
authors.affiliation: Institut de Recherche pour le Développement, Inserm, Université de Montpellier, Unité TransVIHMI , Montpellier , France.
authors.forename: Christian
authors.initials: C
authors.lastname: Laurent
keywords: Africa; antiretroviral; resistance; treatment; virologic failure