High Prevalence of HIV Drug Resistance Among Newly Diagnosed Infants Aged <18 Months: Results From a Nationwide Surveillance in Nigeria

Abstract

A high frequency of PDR, mainly NNRTI-associated, was observed in a nationwide surveillance among newly diagnosed HIV-infected children in Nigeria. PDR prevalence was equally high in PMTCT-unexposed infants. Our results support the use of protease inhibitor-based first-line regimens in HIV-infected young children regardless of PMTCT history and underscore the need to accelerate implementation of the newly disseminated guideline in Nigeria.

Pretreatment HIV drug resistance among adults initiating ART in Namibia

“…PDR mutations associated with efavirenz and nevirapine were observed at rates in this survey that were similar to other studies completed in SSA. 6,19–22 Additionally, resistance to the second- generation NNRTIs rilpivirine and etravirine was observed. Multiple factors could explain the presence of resistance to these ARVs, including: cross-resistance driven by long-standing, population- level exposure to nevirapine and efavirenz; 23 the presence of the E138A mutation as a spontaneous mutation in treatment-naive patients who are infected with HIV subtype C, 24,25 and recent introduction of etravirine and rilpivirine in Namibia for use in salvage therapy regimens.…”

What is new in perinatal HIV prevention?

“…As described in a 2017 meta-analyses review, 39 Boerma et al documented increasingly high rates of ARV resistance over the past decade among HIV infected infants and young children (47%) in 13 countries who failed PMTCT; as well as resistant virus among HIV infected children not reported to be exposed to PMTCT antiretrovirals (26.8%).These include studies from Southern and East Africa 40–42 as well as West Africa with the highest proportion of resistance being to nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs) followed by Nucleoside Reverse Transcriptase Inhibitors (NRTIs). 43–44 Likewise HIV infected pregnant women in international settings have also shown increased rates of resistance to NNRTI and NRTIs’ with a study from KwaZulu-Natal South Africa, 45 reporting 65% of pregnant women having an NNRTI resistance and 7% with TAMS resistance using Ultra-deep sequencing (UDS) assays; and a study from Tanzania reported similar findings with drug resistance mutants in 69% of women based on UDS assays. 46 Persistence of resistant mutations at low levels has been documented in adult European studies to be associated with increased risk of treatment failure.…”

Multilevel modelling and multiple group analysis of disparities in continuity of care and viral suppression among adolescents and youths living with HIV in Nigeria

“…5 8 11 12 This is all the more likely given our speculation that the majority of younger adolescents in our study are perinatally HIV infected compared with older adolescents and younger adults who we assume to be mostly behaviourally infected. Studies from Nigeria [37][38][39] and other African countries 38 40 have reported a rapidly increasing prevalence of PDR among both PMTCT exposed (more than 42%) and PMTCT unexposed (up to 35%) children and young adolescents. Although the majority of these PDR are to non-nucleoside reverse transcriptase inhibitors, increasing rates of multiclass PDR involving nucleoside reverse transcriptase inhibitors are also being reported, and this is concerning because of the potential impact on alternative regimen options.…”