One year of first-line ART in rural Cameroon: the majority of therapy failures is associated with the appearance of drug resistance mutations which were not present prior to ART

Surveillance of antiretroviral treatment (ART) outcome is essential in resource limited settings in order to timely detect therapy failure. Here, we performed a prospective study to investigate the success of first-line ART in rural Cameroon and the risk factors associated with therapy failure. In one HIV treatment centre, 300 patients received first-line ART mainly containing 2 NRTIs plus one NNRTI and were followed-up for 12 months. After one year of first-line ART in rural Cameroon, high rates of ART failure were observed, which were associated with low plasma drug levels rather than transmitted drug resistance mutations. The high rate of NRTI/NNRTI double mutations severely compromise second-line ART options in this setting. Strategies to assure adherence and uninterrupted drug supply are pivotal factors for therapy success.