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首页> 外文期刊>AIDS Research and Human Retroviruses >Virological failure and HIV type 1 drug resistance profiles among patients followed-up in private sector, Douala, Cameroon.
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Virological failure and HIV type 1 drug resistance profiles among patients followed-up in private sector, Douala, Cameroon.

机译：在喀麦隆杜阿拉的私营部门进行随访的患者中，病毒学衰竭和HIV 1型耐药性特征。

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The rate of virological failure was assessed in 819 patients followed up by the private sector of Douala, the economic capital of Cameroon, and treated according to the World Health Organization (WHO) recommendations. In addition, genotypic resistance testing was carried out in the subgroup of 75 selected patients representative of the 254 patients in virological and/or immunological failure receiving a first-line (83%) or second-line (17%) regimen. Overall, 36% of patients treated by antiretroviral drugs (ARV) were in virological failure, as assessed by plasma viral load above 3.7 log(10) copies/ml under treatment for more than 6 months. According to the immunological status, 17% of patients showed a CD4 T cell count under 200 cells/mm(3) and 37% under 350 cells/mm(3), indicating either ongoing immunorestoration or immunological failure under treatment. Twenty percent of patients in virological failure showed wild-type viruses susceptible to all ARV, likely indicating poor adherence. However, 80% of them displayed plasma virus resistant at least to one ARV drug, mostly to the nucleoside reverse transcriptase inhibitors (NRTIs) class (80%), followed by the non-NRTI class (76%) and the protease inhibitor class (19%), thus reflecting the therapeutic usage of ARV drugs in Cameroon as recommended by the WHO. Whereas the second-line regimen proposed by the 2009 WHO recommendations could be effective in more than 75% of patients in virological failure with resistant viruses, the remaining patients showed a resistance genotypic profile highly predictive of resistance to the usual WHO second-line regimen, including in some patients complex genotypic profiles diagnosed only by genotypic resistance tests. In conclusion, our observations highlight the absolute need for improving viral load assessment in resource-limited settings to prevent and/or monitor therapeutic failure.
机译：喀麦隆的经济之都杜阿拉的私营部门对819名患者的病毒学失败率进行了评估，并根据世界卫生组织的建议进行了治疗。此外，在75名选定患者的亚组中进行了基因型耐药性测试，这些患者代表254名接受一线（83％）或二线（17％）方案的病毒学和/或免疫学失败的患者。总体而言，抗血浆病毒负荷超过3.7 log（10）拷贝/ ml且治疗超过6个月的血浆病毒载量评估表明，接受抗逆转录病毒药物（ARV）治疗的患者中有36％处于病毒学衰竭状态。根据免疫状态，17％的患者CD200 T细胞计数低于200细胞/ mm（3），37％的患者CD350 T细胞计数低于350细胞/ mm（3），表明治疗中正在进行的免疫修复或免疫学失败。病毒学衰竭的患者中有20％表现出对所有ARV敏感的野生型病毒，这可能表明依从性差。但是，其中80％的血浆病毒至少对一种ARV药物具有抗性，主要对核苷类逆转录酶抑制剂（NRTIs）具有抗药性（80％），其次是非NRTI类（76％）和蛋白酶抑制剂类别（ 19％），因此反映了WHO推荐的喀麦隆抗逆转录病毒药物的治疗用途。尽管2009年WHO建议中提出的二线方案可以有效治疗超过75％的耐药病毒性病毒感染患者，但其余患者的耐药基因型谱可高度预测对常规WHO二线方案的耐药性，包括在某些患者中仅通过基因型耐药性测试即可诊断出的复杂基因型谱。总之，我们的观察强调了在资源有限的环境中绝对需要改进病毒载量评估，以预防和/或监测治疗失败。

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