Virological Outcome among HIV-1 Infected Patients on First-Line Antiretroviral Treatment in Semi-Rural HIV Clinics in Togo
Access to antiretroviral treatment (ART)
in resource-limited countries has increased significantly but scaling-up ART
into semi-rural and rural areas is more recent. Information on treatment
outcome in such areas is still very limited notably due to additional
difficulties to manage ART in these areas.
387 HIV-1 infected adults
(≥18 years) were consecutively enrolled when attending healthcare services
for their routine medical visit at 12 or 24 months on first-line ART in
five HIV care centers (four semi-rural and one rural). Among them, 102 patients
were on first-line ART for 12 ± 2 months (M12) and 285 for
24 ± 2 months (M24). Virological failure was observed in 70
(18.1 %) patients ranging from 13.9 to 31.6 % at M12 and from 8.1 to
22.4 % at M24 across the different sites. For 67/70 patients, sequencing
was successful and drug resistance mutations were observed in 65 (97 %).
The global prevalence of drug resistance in the study population was thus at
least 16.8 % (65/387). Moreover, 32 (8.3 %) and 27 (6.9 %)
patients were either on a completely ineffective ART regime or with only a
single drug active. Several patients accumulated high numbers of mutations and
developed also cross-resistance to abacavir, didanosine or the new NNRTI drugs
like etravirine and rilpivirine.
The observations on ART treatment
outcome from ART clinics in semi-rural areas are close to previous observations
in Lomé, the capital city suggesting that national ART-programme management
plays a role in treatment outcome.
Below: Togo map indicating locations
of the healthcare centers where patients were enrolled. The sites where samples
were collected for this study are indicated withgrey full circles, and the
name of the corresponding city at theright. Lomé, the capital city, is indicated with ablack full