Anfumbom, J

Calmy, Alexandra

Ciaffi, L

Galli, L

Gianotti, N

Lazzarin, A

Mougnutou, R

Porten, K

Rousset, D

Soria, A

Teck, R

Toundji, J

English

MSF Field Research

XVII INTERNATIONAL
AIDS CONFERENCE
3-8 August 2008 | Mexico City
Poster Exhibition 
Track A - Resistance in Treatment-experienced Patients  
 
WEPE0034 - Drug resistance degree is associated with duration of ARV exposure and predicted by baseline 
CD4 and gender in HIV-infected patients failing first-line WHO-recommended ARV regimen: a cross-sectional 
viral load survey of a cohort in Cameroon (Médecins sans Frontières-Ministry of Health)  
 
A. Soria1, K. Porten2, J.-C. Fampou Toundji3, R. Mougnutou3, J. Kfutwah Anfumbom4, D. Rousset4, R. Teck3, L. Ciaffi5, 
L. Galli1, A. Calmy5, A. Lazzarin1, N. Gianotti1 
  
1San Raffaele Scientific Institute, Infectious Diseases, Milan, Italy, 2Epicentre, Geneva, Switzerland, 3Médecins sans 
Frontières, Yaoundé, Cameroon, 4Centre Pasteur du Cameroun, Yaoundé, Cameroon, 5Médecins sans Frontières, 
Geneva, Switzerland 
  
Background: The absence of routine virologic monitoring in resource-limited settings may favor accumulation of 
resistance mutations, thus hampering second-line treatment efficacy. Knowing predicting factors for resistance extent 
could help to preserve options for future salvage regimens.  
Methods: Cross-sectional viral load (VL) sampling with genotyping for VL >400 copies/mL on cameroonian HIV-
infected subjects receiving ARV (nevirapine/efavirenz, stavudine/zidovudine, lamivudine) since 2001.  
Results: Among 573 subjects with sampled VL, 97 (16.9%) had detectable viremia, 84 were genotyped (70% women). 
The mean number of reverse-transcriptase (RT) and, specifically, NRTI mutations increased per year of ARV exposure 
(0.33, 1.74, 2.81, 2.77 and 0.17, 0.85, 1.27, 1.77 at 1, 2, 3, >3 years; p for trend 0.03 and 0.02, respectively). Baseline 
CD4 counts were correlated with number of RT, NRTI and NNRTI mutations (r=-0.35, -0.38, -0.23; p=0.0009, 0.0003, 
0.04, respectively). Multivariable analysis: by GLM (covariates: age, baseline BMI, baseline CD4£ or >50/mm3, gender, 
WHO stage), the adjusted mean number of RT, NRTI and NNRTI mutations was higher for subjects with baseline CD4£50/
mm3 vs >50/mm3 (3.75 vs 1.32, 2.10 vs 0.56, 1.65 vs 0.76; p<0.0001, <0.0001, 0.005, respectively); the adjusted 
mean number of RT and NNRTI mutations in women vs men was 3.16 vs 1.91, p=0.03 and 1.60 vs 0.81, 
p=0.015, respectively. At logistic regression, being a woman was predictive of ³1 NRTI mutation (OR 4.05, 95%CI 
1.19-16.67); baseline CD4£50/mm3 was predictive of ³1 RT mutation (OR 5.36, 95%CI 1.68-20.58), ³1 NRTI mutation 
(OR 7.49, 95%CI 2.20-32.14), ³1 NNRTI mutation (OR 4.25, 95%CI 1.36-15.48), ³1 TAM (OR 8.45, 95%CI 2.16-40.16), 
and etravirine resistance (OR 4.72, 95%CI 1.53-15.70).  
Conclusions: Failing patients with baseline CD4 £50/mm3 are at higher risk of extensive drug-resistance, that increases 
over time of ARV exposure when virologic monitoring is not available. Earlier ARV initiation, and targeted VL testing, should 
be considered to preserve options for second-line regimens in resource-limited settings.    
Presenting author email: soria.alessandro@hsr.it 

Drug resistance degree is associated with duration of ARV exposure and predicted by baseline CD4 and gender in HIV-infected patients failing first-line WHO-recommended ARV regimen: a cross sectional viral load survey of a cohort in Cameroon (Médecins Sans Frontières - Ministry of Health)

Drug resistance degree is associated with duration of ARV exposure and predicted by baseline CD4 and gender in HIV-infected patients failing first-line WHO-recommended ARV regimen: a cross sectional viral load survey of a cohort in Cameroon (Médecins Sans Frontières - Ministry of Health)

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