Place des troisièmes lignes dans les pays du Sud, par Serge Paul Eholié, Service des Maladies Infectieuses et Tropicales, CHU Treichville, Abidjan.
Une présentation du Symposium Bristol-Myers Squibb - 29 mars 2010 :
Troisièmes lignes de traitement dans les Pays du Sud, des efforts à fournir par tous.
http://www.vih.org/casablanca2010
Le rôle central de la médecine interne dans l’évolution des systèmes de santé...
Casablanca 2010 - La place des 3e ligne dans les pays du Sud - Serge Eholié
1. Place des troisièmes lignes dans les pays du SUD Serge Paul Eholié Service des Maladies Infectieuses et Tropicales, CHU Treichville, Abidjan
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3. Niveau de résistance INRT INNRT IP Haut niveau de résistance -didanosine -lamivudine -Abacavir -Emtricitabine -delavirdine -efavirenz -etravirine -nevirapine -atazanavir -indinavir -lopinavir -nelfinavir Bas niveau de résistance darunavir Résistance intermediare -zidovudine -stavudine -saquinavir -fosamprenavir Sensibilité Ténofovir
10. Low levels of antiretroviral resistant HIV infection in Cameroon that use the WHO public health approach to monitor ART and adequacy with the WHO recommendation for second line therapy Kouanfack C, CID 2009
Key point Among 46,400 routine clinical samples with evidence of PI resistance, 73.9% had no DRV RAMs, and only 6.4% harboured 3 2007 DRV RAMs. This is based on the 2007 list of DRV RAMs. The prevalence of 2007 DRV RAMs has been studied in 98,326 routine clinical samples submitted to Virco between November 2004 and November 2007. 1 Of these samples, 46,400 were PI-resistant, with resistance defined as any change at amino acid positions 30, 32, 36, 46, 47, 48, 50, 53, 54, 73, 82, 84, 88, or 90 (US FDA mutations list). Of these, 73.9% showed no 2007 DRV RAMs, and only 6.4% had 3 2007 DRV RAMs. 2 Reference 1. Lathouwers E, et al. Poster presented at 6th EHDRW 2008 [Poster 68]. 2. De Meyer S, et al. Poster presented at 17th IHDRW 2008 [Poster 31]. Abbreviations DRV, darunavir PI, protease inhibitor RAM, resistance-associated mutation
Key point At 96 weeks, significantly more patients in the DRV/r arm had VL < 50 copies/mL than in the control PI arm (39% vs 9%; p < 0.001). DRV/r patients also had a significantly higher mean change in CD4 cell count (133 vs 15 cells/mm 3 ; p < 0.001). For the POWER trials, the virological response (left graph) was statistically superior for the DRV/r 600/100 mg b.i.d. group at 24 weeks (45% vs 12%), 48 weeks (45% vs 10%), and 96 weeks (39% vs 9%) when compared to the PI control group (all p < 0.001). Of the 59 patients (45%) in the DRV/r group who had a VL < 50 copies/mL at 48 weeks, 47/59 (80%) maintained this response at 96 weeks. The immunological benefits (right graph) were also statistically superior for the DRV/r 600/100 mg b.i.d. group at 24 weeks (92 vs 17 cells/mm 3 ), 48 weeks (102 vs 19 cells/mm 3 ), and 96 weeks (133 vs 15 cells/mm 3 ) when compared to the control PI group (all p < 0.001). References 1. Pozniak A, et al. Poster presented at 11th EACS 2007 [Poster P7.2/07]. 2. Clotet B, et al. Lancet. 2007;369:1169-78. Abbreviations b.i.d., twice daily DRV, darunavir ITT, intention to treat LOCF, last observation carried forward r, low-dose ritonavir SE, standard error TLOVR, time to loss of virological response VL, viral load