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Title: High levels of virological failure with major genotypic resistance mutations in HIV-1-infected children after 5 years of care according to WHO-recommended 1st-line and 2nd-line antiretroviral regimens in the Central African Republic: A cross-sectional study
Authors: Mossoro-Kpinde, Christian Diamant
Gody, Jean-Chrysostome
Mboumba Bouassa, Ralph-Sydney
Mbitikon, Olivia
Jenabian, Mohammad-Ali
Robin, Leman
Matta, Mathieu
Zeitouni, Kamal
Longo, Jean De Dieu
Costiniuk, Cecilia
Grésenguet, Gérard
Touré Kane, Ndèye Coumba
Bélec, Laurent
Affiliations: Faculty of Medicine 
Keywords: Antiretroviral treatment
Central Africa
HIV-1 subtype
Plasma HIV-1 RNA load
Resistance mutations
Virological failure
Virological outcomes
Issue Date: 2017-03
Part of: Medicine (United States)
Volume: 96
Issue: 10
A large cohort of 220 HIV-1-infected children (median [range] age: 12 [4-17] years) was cared and followed up in the Central African Republic, including 198 in 1st-line and 22 in 2nd-line antiretroviral regimens. Patients were monitored clinically and biologically for HIV-1 RNA load and drug resistance mutations (DRMs) genotyping. A total of 87 (40%) study children were virological responders and 133 (60%) nonresponders. In children with detectable viral load, the majority (129; 97%) represented a virological failure. In children receiving 1st-line regimens in virological failure for whom genotypic resistance test was available, 45% displayed viruses harboring at least 1 DRM to NNRTI or NRTI, and 26% showed at least 1 major DRM to NNRTI or NRTI; more than half of children in 1st-line regimens were resistant to 1st-generation NNRTI and 24% of the children in 1st-line regimens had a major DRMs to PI. Virological failure and selection of DRMs were both associated with poor adherence. These observations demonstrate high rate of virological failure after 3 to 5 years of 1st-line or 2nd-line antiretroviral treatment, which is generally associated with DRMs and therapeutic failure. Overall, more than half (55%) of children receiving 1st-line antiretroviral treatment for a median of 3.4 years showed virological failure and antiretroviral-resistance and thus eligible to 2nd-line treatment. Furthermore, two-third (64%) of children under 2nd-line therapy were eligible to 3rd-line regimen. Taken together, these observations point the necessity to monitor antiretroviral-treated children by plasma HIV-1 RNA load to diagnose as early as possible the therapeutic failure and operate switch to a new therapeutic line.
ISSN: 00257974
DOI: 10.1097/MD.0000000000006282
Open URL: Link to full text
Type: Journal Article
Appears in Collections:Faculty of Medicine

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