Abstract

Although viral load (VL) measurement has become the reference tool for monitoring antiretroviral treatment in patients living with HIV, most West African countries do not have it systematically. Long-term virological data are rare. Here, the matter is to describe virological outcomes and resistance patterns at 5 years in HIV-1+ patients and to identify early factors associated with long-term virological outcome. This is a prospective cohort study of 971 HIV-infected adults and measurement of HIV viral load and genotyping test. Association between early factors and virological outcome at 5 years after treatment has been evaluated between 2007 and 2012, in Abidjan, Côte d’Ivoire, West Africa. 971 adults on Non-Nucleoside Reverse Transcriptase Inhibitors were included. At M12, M24 and M60 follow-up, 95, 80 and 65% were on active follow-up. 25, 27 and 29% had detectable viral load, of which 53, 75 and 72% had at least one resistance mutation. Of the 109 viruses resistant to M60, 84% were definitely resistant to NRTIs, 97% to NNRTIs and 13% were possibly or definitely resistant to PIs. Adherence (estimated by the Medication Possession Ratio -MPR) and age were significantly associated with virological outcome at M60. Proportion of patients with high viral load and at least one resistance mutation remains high at M60. MPR is useful as early as month 6 to identify patients who could benefit from early interventions, to reinforce adherence and thus avoid selection and accumulation of resistance.

Key words: Human immunodeficiency virus, virological outcome, medication possession ratio.