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AbstractStavudine is no longer recommended for use in first-line antiretroviral therapy (ART), but it remains in high demand worldwide because it is affordable. We report the clinical presentation and incidence of severe hyperlactatemia (SL) in HIV-infected adults who initiated ART between April 2005 and May 2009 in Côte d'Ivoire, West Africa. In a prospective cohort study at the HIV care center affiliated with the National Centre for Blood Transfusion, we used standardized forms to record baseline and follow-up data. We measured serum lactate levels for all adults on ART who showed signs of hyperlactatemia. SL was defined as serum lactate >2.5 mmol/liter. Overall, 806 adults initiated ART. Among the 591 patients (73%) on stavudine-containing regimens, 394 were women (67%); the median pre-ART CD4 count was 150 /mm3and the median body mass index was 20.9 kg/m2. These patients were followed for a median of 28 months. We detected SL only among patients taking stavudine. The incidence of SL was 0.55/100 person-years (PY) (95% CI 0.47–0.63) overall and 0.85/100 PY among women (95% CI 0.75–0.95). Among the eight patients with SL, 100% lost >9% of body weight before diagnosis, 100% had serum lactate >4 mmol/liter (range 4.2–12.1), 50% had pre-ART BMI >25 kg/m2, and three patients died (38%), accounting for 6.4% of deaths among patients taking stavudine. As long as HIV clinicians continue to use stavudine in sub-Saharan Africa, they should watch out for acute unexplained weight loss in patients taking ART, particularly among women and patients with high pre-ART BMI. [ABSTRACT FROM AUTHOR]

We performed HIV-1 drug resistance genotypic analysis of viral isolates from 100 antiretroviral (ARV)-naive, recently HIV-1-infected (between 2002 and 2006) individuals from Abidjan (Côte d'Ivoire). The overall prevalence of HIV-1 variants with resistance mutations to reverse transcriptase, protease, or fusion inhibitors was 6. The majority of isolates were CRF02_AG. Compared with a previous study carried out by our group in 2001–2002 in a similar population in Abidjan, our findings confirm the circulation and transmission of HIV-1 carrying key ARV drug resistance mutation. [ABSTRACT FROM AUTHOR]

To report the tolerance of indinavir combined with ritonavir (IDVr 800100 mg) twice daily (bid) in sub-Saharan African HIV-infected adults. HAART-naives patients started zidovudine plus lamivudine plus IDVr 800100 mg bid. Follow-up included standardized documentation of morbidity, CD4cell count, creatininemia, plasma HIV-1 RNA, and IDV minimal plasma concentration (Cmin) measurements at month 1 (M1), M3, and M6. Seventy HIV-1-infected adults (68 women, median CD4 235mm3) started HAART. At M6, 63 had undetectable viral load, and the median gain in CD4 since baseline was 128mm3. During the first 6 months, 21 patients experimented with 23 treatment modifications (reduction in IDVr 400100 mg bid, n 11; switch to efavirenz, n 11; zidovudine replaced by stavudine, n 1), including 22 for digestive intolerance and 1 for severe anemia. At M1, M3, and M6, 67, 59, and 48 patients were still receiving IDVr 800100 mg bid, of whom 70, 72, and 60 had IDV Cmin above 5 ngml, respectively. In these patients, at M1, M3, and M6, the mean (± SD) IDV Cminwere 3431 ± 3835 ngml, 2288 ± 2116 ngml, and 1543 ± 2398 ngml, respectively. There was no renal insufficiency of any grade, and no symptoms of urinary stones. The IDVr 800100 mg bid-containing regimen led to high IDV Cmin and a high rate of digestive intolerance. There was a surprising lack of nephrological side effects during the 6 months of follow-up, supporting the hypothesis that nephrological tolerance of IDV might be higher in sub-Saharan African individuals than in Americans or Europeans. [ABSTRACT FROM AUTHOR]