GH12-008, Cameroon, Evaluation of HIV-1 Drug Resistance among Antiretroviral Treatment Naive and Expe

项目摘要） HIV-1耐药性在抗逆转录病毒治疗初治者和初治者中的评价 有经验的病人参加城市和周边农村治疗中心， 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 这对发展中国家的脆弱经济体和卫生系统来说是一个具体挑战， 资源有限的环境（RLS），更具体地说，在撒哈拉以南非洲。尽管各大 在过去的三十年里，取得了进展，特别是在 药物和药物组合的开发、艾滋病毒/艾滋病患者获得抗逆转录病毒治疗的机会 发展中国家仍然面临挑战。为了应对这些挑战， 包括在以下情况下开始和转换抗逆转录病毒疗法的具体指南： RLS。世界卫生组织（世卫组织）及其合作伙伴制定的这些指南 我推荐一种简单的方法，不需要或只需要很少的生物标记物进行治疗 启动和转换，因此与目前的建议大不相同， 工业化国家，其中几个生物学和病毒学标志物，包括病毒载量 并且常规使用耐药性评估。在这种情况下， 在接受治疗的患者中迅速出现耐药性的风险 治疗RLS，但也适用于最近感染和未接受治疗的患者， 抵抗病毒的传播。 目前的应用旨在确定传播HIV-1药物的频率 新感染患者中的耐药菌株，并监测艾滋病病毒的出现和相关 喀麦隆城市和农村抗逆转录病毒治疗点的方案因素， 向方案管理人员和决策者提出关于如何改善获得 喀麦隆和其他RLS的ART。更具体地说，我们将（i）确定 最近感染的HIV-1耐药株，治疗初治个体， 喀麦隆城乡地区，（二）估计成功治疗的患者比例 12至36个月ART后的治疗结果，并确定与治疗相关的因素 失败，（iii）确定耐药突变和突变模式，在循环 ㈣评估干血等实地友好工具的可行性和可靠性 用于病毒载量检测和耐药基因分型的标本，（v）评价 喀麦隆目前的HIV-1分子流行病学，最后（vi）评估方案 可能与预防或出现艾滋病相关的因素，并提供 向国家当局提出建议。 这项研究计划为期两年，将覆盖几乎所有的爱沙尼亚地区。 从北部地区到南部地区。所取得的成果将是必不可少的， 指导喀麦隆的ART计划，不仅改善治疗的可及性， 以及正在进行和未来治疗的质量。改善RLS中抗逆转录病毒治疗的可及性和质量 必须更有效地利用有限的可用资源，并防止 耐药病毒的不受控制的传播可能会严重影响目前的成就。满足 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小组进行。 喀麦隆新发疾病研究中心（CREMER）， 专门研究艾滋病毒遗传多样性和相关后果，艾滋病毒耐药性， 艾滋病毒来源。CREMER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. )