Antiretroviral Treatment and Resistance Patterns in HIV-Infected Children

Adetokunboh, Olatunji; Atibioke, Oluyemi; Balogun, Tolulope; Oluwasanu, Mojisola

doi:10.1007/s11908-015-0502-9

Cited by 4 publications

(2 citation statements)

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“…In HIV-infected children of all ages, ART dramatically reduces morbidity and mortality, but they are at high risk of developing resistance to the different classes (Adetokunboh et al, 2015). As shown in previous reports, (Charpentier et al, 2012) we observed high rates of resistance to both nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors.…”

Section: Discussionsupporting

confidence: 80%

The changing profile of paediatric HIV infection: An experience from the Middle East

Sawai

Elgalib

Waili

et al. 2020

International Journal of Infectious Diseases

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To describe the clinical and epidemiological profiles of HIV-infected Omani children before and after the implementation of the prevention of mother-to-child transmission of HIV (PMTCT) programme. Methods: A retrospective review of HIV-infected children seen at a national paediatric HIV unit between 1992 and 2015 was performed.Results: Ninety-one HIV-infected children were identified; 59 (65%) were 5 years of age at diagnosis, with 28 (47.5%) of these being <1 year old. The average annual incidence of infection per million children (14 years old) was 5.7, and the highest (11.6) was in 2010. At diagnosis, 48 (60%) patients had a CD4 count of ˂200 cells/mm 3 . The median HIV viral load was 81 600 copies/ml at diagnosis and 5911 copies/ml at 12 months after HIV treatment (p = 0.015). The median CD4 count was 586 cells/mm 3 at diagnosis and 800 cells/mm 3 at 12 months after therapy (p = 0.004). Compared to those diagnosed before 2009 (n = 68), HIV-infected children diagnosed after 2009 (n = 22) were more likely to be asymptomatic at the time of HIV diagnosis (23.5% (16/68) vs. 59.1% (13/22); p = 0.002) and to have a favourable clinical outcome (42.6% (29/68) vs. 86.4% (19/22); p < 0001). Conclusions: The number of HIV-infected children in Oman has decreased substantially since the introduction of the PMTCT programme. Furthermore, the HIV-infected children diagnosed after 2009 had higher proportions of asymptomatic HIV infections at diagnosis and favourable clinical outcomes, in comparison to those diagnosed before 2009.

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Section: Discussionsupporting

confidence: 80%

The changing profile of paediatric HIV infection: An experience from the Middle East

Sawai

Elgalib

Waili

et al. 2020

International Journal of Infectious Diseases

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“…Young children infected with HIV are at an increased risk of developing drug resistance because of their immature immune responses. In addition, maternal lack of adherence, dosing difficulties due to variable infant pharmacokinetics, changing body weight and poorly formulated pediatric formulations can also result in reduced ARV efficacy [6–9] .…”

Section: Introductionmentioning

confidence: 99%

HIV drug resistance in infants increases with changing prevention of mother-to-child transmission regimens

Poppe

Chunda‐Liyoka

Kwon

et al. 2017

Aids

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Objectives The objectives of this study were to determine HIV drug resistance prevalence in Zambian infants upon diagnosis, and to determine how changing prevention of mother-to-child transmission (PMTCT) regimens affect drug resistance. Design Dried blood spot (DBS) samples from infants in the Lusaka District of Zambia, obtained during routine diagnostic screening, were collected during four different years representing three different PMTCT treatment regimens. Methods DNA extracted from DBS samples was used to sequence a 1493 bp region of the RT gene. Sequences were analyzed via the Stanford HIV Drug Resistance (HIVDR) Database (http://hivdb.standford.edu) to screen for resistance mutations. Results HIVDR in infants increased from 21.5% in 2007/2009 to 40.2% in 2014. Non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance increased steadily over the sampling period, while nucleoside reverse transcriptase inhibitor (NRTI) resistance and dual class resistance both increased more than threefold in 2014. Analysis of drug resistance scores in each group revealed increasing strength of resistance over time. In 2014, children with reported PMTCT exposure, defined as infant prophylaxis and/or maternal treatment, showed a higher prevalence and strength of resistance compared to those with no reported exposure. Conclusions HIVDR is on the rise in Zambia and presents a serious problem for successful lifelong treatment of HIV infected children. PMTCT affects both the prevalence and strength of resistance and further research is needed to determine how to mitigate its role leading to resistance.

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Characterization of drug resistance and the defective HIV reservoir in virally suppressed vertically infected children in Mali

Brice

Sylla

Désiré

et al. 2020

Journal of Antimicrobial Chemotherapy

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Background In the perspective of ART-free HIV remission, vertically infected children treated with suppressive ART from early infancy represent an optimal population model to better understand the genetic complexity of the reservoir. Objectives To evaluate the proportion of defective viral population and the genotypic resistance patterns in cell-associated HIV DNA. Methods In a cohort including 93 ART-treated vertically HIV-infected (VHIV) children in Mali with plasma HIV-1 RNA ≤50 copies/mL for at least 6 months, we studied total HIV DNA, percentage of defective genomes and resistance by reverse transcriptase and protease bulk sequencing from whole blood in dried blood spots. Results Children had a median age of 9.9 years at the time of inclusion (IQR = 7.6–13.4) and 3.3 years (IQR = 2–7) at ART initiation; median ART duration was 5.5 years (IQR = 3.7–7.3). The median level of total HIV DNA was 470 copies/106 cells with one patient presenting undetectable HIV DNA (<66 copies/106 cells). We observed the presence of at least one stop codon in viruses from 34 patients (37%). The presence of stop codons was not correlated with the level of HIV DNA or duration of ART. We showed a high prevalence of HIV-1 resistance in DNA with 26% of children harbouring virus resistant to at least one NRTI and 40% to at least one NNRTI. Conclusions While these VHIV children were successfully treated for a long time, they showed high prevalence of resistance in HIV DNA and a moderate defective HIV reservoir.

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Antiretroviral Treatment and Resistance Patterns in HIV-Infected Children

Cited by 4 publications

References 46 publications

The changing profile of paediatric HIV infection: An experience from the Middle East

The changing profile of paediatric HIV infection: An experience from the Middle East

HIV drug resistance in infants increases with changing prevention of mother-to-child transmission regimens

Characterization of drug resistance and the defective HIV reservoir in virally suppressed vertically infected children in Mali

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