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Prevalence of genotypic and phenotypic HIV-1 drug-resistant strains
among patients who have rebound in viral load while receiving antiretroviral
therapy in the UNAIDS-Drug Access Initiative in Abidjan, Cote d'Ivoire.
AIDS 2003;17(Suppl 3):S23-S29.
Adjé-Touré CA, Celestin B, Hanson D, Roels TH, Hertogs
K, Larder B, Diomande F, Peeters M, Eholié S, Lackritz E, Chorba
T, Nkengasong JN.
Abstract
OBJECTIVE: To determine the prevalence of genotypic and phenotypic antiretroviral
(ARV) drug-resistant HIV-1 strains among patients with viral load rebound
while receiving ARV therapy in Abidjan, Cote d'Ivoire. METHODS: Between August
1998 and April 2000, we selected all patients (n = 241) who had received
ARV drug therapy for at least 6 months in the UNAIDS-Drug Access Initiative
(DAI), in Abidjan. We analyzed for genotypic and phenotypic drug resistance
among 97 (40%) of the 241 patients who had a rebound in plasma viral load,
defined as an initial decrease of > 0.5 log10 copies/ml followed by a
subsequent increase of > 0.25 log10 copies/ml. RESULTS: Of the viruses
isolated from the 97 patients, 86 (88.7%) had usable sequences and 68 (79%)
of the 86 patients had genotypic resistance to at least one reverse transcriptase
inhibitor (RTI) or protease inhibitor (PI). Resistant mutations were found
for zidovudine in 50 (78%) of 64 patients who had received the drug, 11 (68.7%)
of 16 patients on lamivudine, for nevirapine in two (2%), for indinavir in
one (1%), and for ritonavir in one (1%). Phenotypic resistance to at least
one nucleoside RTI was seen in 45 (56%) of the 80 patients tested, to non-nucleoside
RTIs in eight (10%), and to PIs in one (1.3%). Multivariate regression analysis
showed factors associated with resistance to be initial treatment with dual
therapy (P = 0.04) compared with highly active antiretroviral therapy, and
maximal initial viral load response (P = 0.006). CONCLUSION: Our results
demonstrate a high prevalence of ARV drug resistance associated with dual
ARV therapy. These results indicate the limited role for dual ARV therapy.