Evaluation of HIV-1 Drug Resistance among Antiretroviral Treatment Naive and Expe

项目摘要) 抗逆转录病毒药物NaVe和NaVe对HIV-1耐药性评价 在城市和周边乡村治疗中心就诊的有经验的患者 喀麦隆。 项目摘要 全世界艾滋病毒/艾滋病感染的全球负担是所有人的主要关切 但对脆弱的经济和卫生系统来说是一个特殊的挑战 资源有限的环境(RLS)，更具体地说在撒哈拉以南非洲。虽然主要的 过去三十年来取得了进展，特别是在以下方面 开发药物和药物组合，获得抗逆转录病毒治疗(ART) 发展中世界仍然充满挑战。为了应对这些挑战，有几项举措 已制定，包括在以下背景下启动和转换ART的具体准则 RLS。这些指南由世界卫生组织(WHO)和合作伙伴制定 推荐一种不需要或只需要很少生物标志物进行治疗的简化方法 启动和切换，因此与当前建议的 工业化国家，包括病毒载量在内的几个生物和病毒学标志 耐药性评估是常规使用的方法。在这种情况下，因此有一个 在接受治疗的患者中迅速出现抗药性的风险 在RLS接受治疗，但也适用于最近感染且无需治疗的人，通过 耐药病毒的传播。 目前的应用旨在确定传播HIV-1药物的频率 新感染患者的耐药株与HIVDR的出现及相关监测 喀麦隆城乡艺术场所的方案因素，以便提供足够的 向计划经理和决策者提出建议，说明如何改善获取 喀麦隆的ART和其他RLS。更具体地说，我们将(I)确定 在新近感染、接受治疗的人中传播的HIV-1耐药株 喀麦隆城市和农村地区，(2)估计成功的患者比例 12-36个月的抗逆转录病毒治疗和确定与治疗相关的因素的治疗结果 失败，(Iii)确定在人类免疫系统中传播的耐药突变和突变模式 人口；(4)评估干血等野外友好工具的可行性和可靠性 用于病毒载量测试和耐药基因分型的样本；(V)评估 喀麦隆目前的艾滋病毒-1分子流行病学和最后(Vi)评估方案 可能与预防或出现HIVDR相关的因素和提供 向国家当局提出建议。 这项研究计划为期两年，将覆盖喀麦隆几乎所有地区 从国家的北部，到南部地区。所获得的结果将对 指导喀麦隆的抗逆转录病毒治疗方案如何不仅改善获得治疗的机会，而且 还有正在进行和未来治疗的质量。改善RLS中ART的获取和质量 对于更有效地利用有限的可用资源至关重要，也是防止 抗药性病毒的不受控制的传播，可能会极大地影响当前的成就。相遇 为了实现这些目标，这项研究将由一个在艾滋病毒领域经验丰富的团队进行 非洲研究、喀麦隆新发疾病研究中心(克里默)、 专门研究艾滋病毒遗传多样性及其相关后果、艾滋病毒耐药性和 艾滋病毒来源。克里默病毒学实验室是世卫组织认可的参考实验室 HIV-1耐药性监测。 )

Project Abstract) Evaluation of HIV-1 Drug Resistance among Antiretroviral Treatment Na¿ve and Experienced Patients Attending Urban and Peripheral Rural Treatment Centers in Cameroon. PROJECT ABSTRACT The global burden of HIV/AIDS infection worldwide is a major concern for all countries, but represents a specific challenge for fragile economies and health systems in resource-limited settings (RLS), and more specifically in Sub-Saharan Africa. Although major progresses have been achieved over the past three decades, especially in terms of development of drugs and drug-combinations, access to antiretroviral treatment (ART) in the developing world is still challenging. To address these challenges, several initiatives have been developed, including specific guidelines for ART initiation and switch in the context of RLS. These guidelines developed by the World Health Organization (WHO) and partners recommend a simplify approach that requires no or few biological markers for treatment initiation and switch and are thus quite different from current recommendations in industrialized countries, where several biological and virological markers including viral load and drug resistance evaluations are routinely used. Under such circumstances, there is thus a risk that resistance to treatment will emerge rapidly among patients who are receiving treatment in RLS, but also in those who are recently infected and are treatment-free, through transmission of resistant viruses. The current application aims at determining the frequency of transmitted HIV-1 drug resistant strains in newly infected patients and monitor HIVDR emergence and related program factors in urban and rural ART sites in Cameroon in order to provide adequate recommendations to program managers and decision makers on how to improve access to ART in Cameroon and other RLS. More specifically, we will (i) determine the frequency of transmitted HIV-1 drug resistant strains in recently infected, treatment-na¿ve individuals in urban and rural areas in Cameroon, (ii) estimate the proportion of patient with successful treatment outcome after 12 to 36 months ART and identify factors associated with treatment failure, (iii) identify drug resistance mutations and mutation patterns that circulate in the population, (iv) assess the feasibility and reliability of field-friendly tools as dried blood specimens for the purpose of viral load testing and drug resistance genotyping, (v) evaluate the current HIV-1 molecular epidemiology in Cameroon and finally (vi) assess programmatic factors potentially associated with the prevention or emergence of HIVDR and provide recommendations to national authorities. The study is planned for two years, and will cover almost all Cameroonian regions from the north part of the country, to the south areas. The obtained results will be essential to guide the ART-program in Cameroon on how to improve not only access to treatment, but also the quality of ongoing and future treatment. Improving access and quality of ART in RLS is essential to use more efficiently, the limited available resources and also prevent an uncontrolled spread of resistant viruses that can highly affect current achievements. To meet these objectives, the study will be conducted by a highly experienced team in the field of HIV research in Africa, the Research Center for Emerging Diseases in Cameroon (CREMER), specialized in HIV genetic diversity and associated consequences, HIV drug resistance and HIV origin. The CREMER Virology Laboratory is a WHO accredited reference laboratory for the surveillance of HIV-1 drug resistance. )