High levels of pre-treatment HIV drug resistance and treatment failure in Nigerian children.

Autor:	Boerma RS; Amsterdam Institute for Global Health and Development & Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.; Global Child Health Group, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; r.boerma@aighd.org., Boender TS; Amsterdam Institute for Global Health and Development & Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.; Global Child Health Group, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.; Stichting HIV Monitoring, Amsterdam, The Netherlands., Sigaloff KC; Amsterdam Institute for Global Health and Development & Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.; Division of Infectious Diseases, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands., Rinke de Wit TF; Amsterdam Institute for Global Health and Development & Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands., van Hensbroek MB; Global Child Health Group, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands., Ndembi N; Institute of Human Virology Nigeria, Abuja, Nigeria., Adeyemo T; Lagos University Teaching Hospital, University of Lagos, Lagos, Nigeria., Temiye EO; Lagos University Teaching Hospital, University of Lagos, Lagos, Nigeria., Osibogun A; Lagos University Teaching Hospital, University of Lagos, Lagos, Nigeria., Ondoa P; Amsterdam Institute for Global Health and Development & Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands., Calis JC; Global Child Health Group, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.; Department of Paediatric Intensive Care, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands., Akanmu AS; Lagos University Teaching Hospital, University of Lagos, Lagos, Nigeria.
Jazyk:	angličtina
Zdroj:	Journal of the International AIDS Society [J Int AIDS Soc] 2016 Nov 10; Vol. 19 (1), pp. 21140. Date of Electronic Publication: 2016 Nov 10 (Print Publication: 2016).
DOI:	10.7448/IAS.19.1.21140
Abstrakt:	Introduction: Pre-treatment HIV drug resistance (PDR) is an increasing problem in sub-Saharan Africa. Children are an especially vulnerable population to develop PDR given that paediatric second-line treatment options are limited. Although monitoring of PDR is important, data on the paediatric prevalence in sub-Saharan Africa and its consequences for treatment outcomes are scarce. We designed a prospective paediatric cohort study to document the prevalence of PDR and its effect on subsequent treatment failure in Nigeria, the country with the second highest number of HIV-infected children in the world. Methods: HIV-1-infected children ≤12 years, who had not been exposed to drugs for the prevention of mother-to-child transmission (PMTCT), were enrolled between 2012 and 2013, and followed up for 24 months in Lagos, Nigeria. Pre-antiretroviral treatment (ART) population-based pol genotypic testing and six-monthly viral load (VL) testing were performed. Logistic regression analysis was used to assess the effect of PDR (World Health Organization (WHO) list for transmitted drug resistance) on subsequent treatment failure (two consecutive VL measurements >1000 cps/ml or death). Results: Of the total 82 PMTCT-naïve children, 13 (15.9%) had PDR. All 13 children harboured non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations, of whom seven also had nucleoside reverse transcriptase inhibitor resistance. After 24 months, 33% had experienced treatment failure. Treatment failure was associated with PDR and a higher log VL before treatment initiation (adjusted odds ratio (aOR) 7.53 (95%CI 1.61-35.15) and 2.85 (95%CI 1.04-7.78), respectively). Discussion: PDR was present in one out of six Nigerian children. These high numbers corroborate with recent findings in other African countries. The presence of PDR was relevant as it was the strongest predictor of first-line treatment failure. Conclusions: Our findings stress the importance of implementing fully active regimens in children living with HIV. This includes the implementation of protease inhibitor (PI)-based first-line ART, as is recommended by the WHO for all HIV-infected children <3 years of age. Overcoming practical barriers to implement PI-based regimens is essential to ensure optimal treatment for HIV-infected children in sub-Saharan Africa. In countries where individual VL or resistance testing is not possible, more attention should be given to paediatric PDR surveys. Competing Interests: The authors declare no competing interests.
Databáze:	MEDLINE
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