Virologic failure and human immunodeficiency virus drug resistance in rural Cameroon with regard to the UNAIDS 90-90-90 treatment targets

Charlotte Boullé (1) , Emilande Guichet (1) , Charles Kouanfack (2) , Avelin Aghokeng (1) , Benjamin Onambany , Catherine Massama Ikaka , Emile Ngock , Landry Tsoumsta , Philippe Msellati (1) , Eitel Mpoudi-Ngole , Martine Peeters (1) , Eric Delaporte (1) , Christian Laurent (1)

1 TransVIHMI - Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes
2 Hôpital Central de Yaoundé [Yaoundé]

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.

Mots clés: Africa; antiretroviral; resistance; treatment; virologic failure

Domaines: Médecine humaine et pathologie

Charlotte Boullé, Emilande Guichet, Charles Kouanfack, Avelin Aghokeng, Benjamin Onambany, et al.. Virologic failure and human immunodeficiency virus drug resistance in rural Cameroon with regard to the UNAIDS 90-90-90 treatment targets. Open Forum Infectious Diseases, 2016, 3 (4), pp.ofw233. ⟨10.1093/ofid/ofw233⟩. ⟨hal-01814410⟩