Characterization of HIV-1 antiretroviral drug resistance after second-line treatment failure in Mali, a limited-resources setting

Almoustapha Issiaka Maiga*, Djeneba Bocar Fofana, Mamadou Cisse, Fodié Diallo, Moussa Youssoufa Maiga, Hamar Alassane Traore, Issouf Alassane Maiga, Aliou Sylla, Dionke Fofana, Babafemi Taiwo, Robert Murphy, Christine Katlama, Anatole Tounkara, Vincent Calvez, Anne Geneviève Marcelin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Objectives: We describe the outcomes of second-line drug resistance profiles and predict the efficacy of drugs for third-line therapy in patients monitored without the benefit of plasma HIV-1 RNA viral load (VL) or resistance testing. Methods: We recruited 106 HIV-1-infected patients after second-line treatment failure in Mali. VL was determined by the Abbott RealTime system and the resistance by the ViroSeq HIV-1 genotyping system. The resistance testing was interpreted using the latest version of the Stanford algorithm. Results: Among the 106 patients, 93 had isolates successfully sequenced. The median age, VL and CD4 cells were respectively 35 years, 72 000 copies/mL and 146 cells/mm3. Patients were exposed to a median of 4 years of treatment and to six antiretrovirals. We found 20% of wild-type viruses. Resistance to etravirine was noted in 38%, to lopinavir in 25% and to darunavir in 12%. The duration of prior nucleos(t)ide reverse transcriptase inhibitor exposure was associated with resistance to abacavir (P < 0.0001) and tenofovir (P = 0.0001), and duration of prior protease inhibitor treatment with resistance to lopinavir (P < 0.0001) and darunavir (P = 0.06). Conclusion: Long duration of therapy prior to failure was associated with high levels of resistance and is directly related to limited access to VL monitoring and delayed switches to second-line treatment, precluding efficacy of drugs for third-line therapy. This study underlines the need for governments and public health organizations to recommend the use of VL monitoring and also the availability of darunavir and raltegravir for third-line therapies in the context of limited-resource settings.

Original languageEnglish (US)
Article numberdks310
Pages (from-to)2943-2948
Number of pages6
JournalJournal of Antimicrobial Chemotherapy
Issue number12
StatePublished - Dec 2012


  • Africa
  • Resistance
  • Third-line

ASJC Scopus subject areas

  • Pharmacology
  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)


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