Rapid Development of Antiretroviral Drug Resistance Mutations in HIV-Infected Children Less Than Two Years of Age Initiating Protease Inhibitor-Based Therapy in South Africa
In: AIDS research and human retroviruses, Jg. 27 (2011), Heft 9, S. 945-956
academicJournal
- print, 54 ref
Zugriff:
Data on the development of antiretroviral drug resistance in HIV-1-infected children receiving protease inhibitor (PI)-based antiretroviral therapy (ART) are limited. We examined antiretroviral resistance among a cohort of 323 South African HIV-infected children <2 years old exposed to nevirapine for prevention of mother-to-child transmission. Ritonavir (RTV) was used initially for 138 children who were < 6 months old or receiving anti-mycobacterial therapy; otherwise children received lopinavir/ritonavir (LPV/r)-based ART. HIV-1 population sequencing of the pol gene was conducted on all pretreatment samples and on posttreatment samples for children who did not achieve HIV-1 plasma RNA <400 copies/ml by 52 weeks. Among children in the cohort, 38 died, 22 had < 24 weeks follow-up, 209 achieved virologic suppression, and 54 did not. Of 41 children without virologic suppression with posttreatment HIV genotype data available, major resistance mutations were found in 32 (78%): 14 (36%) had PI mutations including V82A, M46I, and L90M; 29 (71%) had M184V/I; and three had NNRTI mutations (K103N, Y181C, and G190A). Among the children who did not achieve virologic suppression, none of the seven children treated exclusively with LPV/r developed PI-related mutations, compared with 14 of 32 (44%) who received RTV-based regimens ( p = 0.036); PI genotypes were unavailable for two children. Seventy-eight percent of children without virologic suppression developed resistance mutations that impact second-line ART options. Only children who received RTV-based ART developed major PI-related resistance mutations, and use of this regimen should be avoided.
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Rapid Development of Antiretroviral Drug Resistance Mutations in HIV-Infected Children Less Than Two Years of Age Initiating Protease Inhibitor-Based Therapy in South Africa
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Autor/in / Beteiligte Person: | TAYLOR, Barbara S ; HUNT, Gillian ; ABRAMS, Elaine J ; COOVADIA, Ashraf ; MEYERS, Tammy ; SHERMAN, Gayle ; STREHLAU, Renate ; MORRIS, Lynn ; KUHN, Louise |
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Zeitschrift: | AIDS research and human retroviruses, Jg. 27 (2011), Heft 9, S. 945-956 |
Veröffentlichung: | New Rochelle, NY: Liebert, 2011 |
Medientyp: | academicJournal |
Umfang: | print, 54 ref |
ISSN: | 0889-2229 (print) |
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