Transcript Salou-Mouneroux

Mounerou SALOU, Anoumou Y. DAGNRA Christelle BUTEL, Abla A.KONOU, Nicole VIDAL, Laetitia
SERRANO, Elom TAKASSI, Spero,HOUNDENOU, Sylvia DAPAM, Yao ATAKOUMA, Assetina SINGOTOKOFAÏ, Mireille PRINCE-DAVID, Palokinam PITCHE, Eric DELAPORTE and Martine PEETERS
abstract MOABO105
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BURKINA FASO
Savanes
0.6%
• Population : 6,934,169 inhabitants
Kara
1.6%
• 6 Sanitary regions
• UNAIDS (2014)
Centrale
GHANA
- HIV prevalence : 2.5% = 110,000 PLHIV
- Higher prevalence in southern regions
3%
BENIN
Plateaux
3.2%
- PLVIH on ART : 37,0000
Maritime
3%
- Children on ART : 2,800
Lomé 7.6%
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• 2008 : Free access to ART started
• 2009: HIV Early Infant Diagnosis implemented
• 2013: NAIDS program advocates 1 VL test per PLHIV on ART per year
Findings:
VL testing is often
lacking in the
country
Outcome ?
- Virological failure ?
- Emergence of Drug
Resistance Mutations?
What about people on ART ?
especially children and adolescents
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Objectives
Assess virological outcomes among HIV-1
infected children and adolescents receiving ART
according to the national guidelines in Togo
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Methods
(1)
• Cross sectional study june - september 2014
• HIV-1 infected patients aged 2 - 19 years on ART>12 months were
consecutively enrolled
• Collection K3-EDTA whole blood
DBS confection
- DBS Whatman 903
- Storage -80°C
- Plasma aliquoted and stored -20°C
- Viral Load testing m2000 rt Abbott
in reference lab (Lomé / Togo)
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Methods
(2)
- Epidemiological data, demographic information and ART history collected
during sampling with a standardized questionnaire from medical records
- DBS samples of Plasma samples with Viral Load testing ≥ 1000 copies /ml
(WHO criteria for Virological failure sent to IRD Montpellier (France) :
• Genotypic drug resistance testing : protocol ANRS
Pol gene region : Protease and Reverse Transcriptase
• Interpretation of relevant Drug Resistance Mutations :
ANRS algorithm version 24
(www.hivfrenchresistance.org/2014/Algo-2014.pdf)
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Results
(1)
• 286 HIV-1 infected pediatrics patients were recruited
- median age : 10 years IQR [ 8-13 years] female 50.7%
Savanes
Children (2-9 years) n= 116 (40.6%)
Adolescents (10-19 years) n=170 (59.4%)
Kara n=70
- cART at sampling time
AZT+3TC+NVP n = 231 (80.8%)
Centrale
ABC /TDF+3TC+ NVP/EFV) n= 27 (9.4%)
PI-based regimen n=28 (9.8%)
Plateaux
n=15
- median duration of ART : 48 months IQR [28-68 months]
n=9
Maritime
Lomé commune n=192
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Results
(2):Virological
failure rates
54.30%
50%
182(63.3%)
VL> 40 copies/ml
48.90%
48.60%
46.90%
52.40%
55.60%
25%
52.20%
55.70%
147 (51.4%) VF
126 Genotyped
Duration of ART
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Results (3): Drug resistant strains
Prevalence of Drug resistant strains:94.4%
88.10%
prevalent NRTI mutations
M184 V/I : 91.7%
T215Y/F : 42.1%
5.60%
Susceptible
NNRTI+NRTI
Prevalent NNRTI mutations
Y181C: 40.5%
K103N: 38.9%
0.80%
3.20%
2,40%
NRTI only
NNRTI only
PI+NNRTI+NRTI
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Results
(4):
TAMs, Q151M complex
Appearance and Duration of ART
12-24 25-36 37-48 49-60 61-72 >72
Total
months months months months months months
18
30
14
20
14
30
126
n strains
Sequenced
1 TAM
5
3
4
2 TAMs
2
1
1
≥3 TAMs
0
9
2
Total
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13
7
TAMs
(38.9%) (43.3%) (50%)
Carriers
Q151M
0
0
0
0
3
9
24
4
1
4
13
8
6
7
32
12
10
20
69
(60%) (71.4%) (66.7%) (54.8%)
0
0
2
12
2
Results(5): Effectivness of cART at
Sampling Time
86.5%
44.40%
39.70%
No effective ART
or 1 effective drug
in current cART
5.60%
7.90%
2.40%
Resistant to Resistant to Resistant to Resistant to Resistant to
0/3
1/3
2/3
2/3+1I
3/3
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Results
(6):
susceptibility to ABC,TDF, DDI
Prevalence of sensitivity
DDI
85.7%
ABC
69.8%
TDF
81.7%
TDF
2.4%
DDI
6.3%
Cross resistance
ABC
15.8%
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Conclusions
- Half of this paediatric cohort on ART > 12 months was at VF
due to high prevalence of NRTI and NNRTI resistance mutations
- Limitations to apply WHO guidelines with 2 NRTI for second line
ART in children.
- Monitoring lifelong ART in children in resource-limited countries
can have dramatic long-term outcomes
Needs: access to routine viral load monitoring
use of more potent PI- based regimens
adapted formulations for the different age classes
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- FSS /UL
Acknowledgments
MOH Togo
Lab Biolim team : Pr M. David Pr AY Dagnra
UMI 233 team : Pr E. Delaporte Dr M. Peeters Dr N. Vidal
Dr A. Ayouba
Health care centres for PLHIV: Lomé, Tsévié, Kpalimé,
Atakpamé , Kara, bafilo,
Bassar
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