HIV Drug Resistance Patterns and Characteristics Associated with Clinically Significant Drug Resistance among Children with Virologic Failure on Antiretroviral Treatment in Kenya: Findings from the Opt4Kids Randomized Controlled Trial.

Autor: Abuogi L; Department of Pediatrics, University of Colorado, Denver, CO 80045, USA., Oyaro P; Health Innovations Kenya (HIK), Kisumu 40100, Kenya.; United States Agency for International Development, Washington, DC 20004, USA., Wakjira G; Department of Medicine, University of Washington, Seattle, WA 98195, USA., Thomas KK; Department of Global Health, University of Washington, Seattle, WA 98105, USA., Scallon AJ; Department of Global Health, University of Washington, Seattle, WA 98105, USA., Mukui I; Drugs for Neglected Diseases Initiative (DNDI), Nairobi 21936, Kenya., Chohan BH; Department of Global Health, University of Washington, Seattle, WA 98105, USA.; Kenya Medical Research Institute, Nairobi 00200, Kenya., Brown E; UWKenya, Nairobi 00200, Kenya., Karauki E; UWKenya, Nairobi 00200, Kenya., Yongo N; UWKenya, Nairobi 00200, Kenya., Ahmed B; Department of Pediatrics, University of Colorado, Denver, CO 80045, USA., Hassan SA; Department of Medicine, University of Washington, Seattle, WA 98195, USA., Wagude J; Department of Health, Ministry of Health, Siaya 40600, Kenya., Kinywa E; Department of Health, Ministry of Health, Kisumu 40100, Kenya., Otieno L; Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu 40100, Kenya., Kingwara L; National HIV Reference Laboratory, Kenya Ministry of Health, Nairobi 00202, Kenya., Oyaro B; Kenya Medical Research Institute-CDC, Kisumu 40100, Kenya., Frenkel LM; Department of Medicine, University of Washington, Seattle, WA 98195, USA.; Department of Global Health, University of Washington, Seattle, WA 98105, USA.; Departments of Pediatrics, University of Washington, Seattle, WA 98195, USA.; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA., John-Stewart G; Department of Medicine, University of Washington, Seattle, WA 98195, USA.; Department of Global Health, University of Washington, Seattle, WA 98105, USA.; Departments of Pediatrics, University of Washington, Seattle, WA 98195, USA., Patel RC; Department of Medicine, University of Washington, Seattle, WA 98195, USA.; Department of Global Health, University of Washington, Seattle, WA 98105, USA.
Jazyk: angličtina
Zdroj: Viruses [Viruses] 2023 Oct 12; Vol. 15 (10). Date of Electronic Publication: 2023 Oct 12.
DOI: 10.3390/v15102083
Abstrakt: Increasing HIV drug resistance (DR) among children with HIV (CHIV) on antiretroviral treatment (ART) is concerning. CHIV ages 1-14 years enrolled from March 2019 to December 2020 from five facilities in Kisumu County, Kenya, were included. Children were randomized 1:1 to control (standard-of-care) or intervention (point-of-care viral load (POC VL) testing every three months with targeted genotypic drug resistance testing (DRT) for virologic failure (VF) (≥1000 copies/mL)). A multidisciplinary committee reviewed CHIV with DRT results and offered treatment recommendations. We describe DR mutations and present logistic regression models to identify factors associated with clinically significant DR. We enrolled 704 children in the study; the median age was 9 years (interquartile range (IQR) 7, 12), 344 (49%) were female, and the median time on ART was 5 years (IQR 3, 8). During the study period, 106 (15%) children had DRT results (84 intervention and 22 control). DRT detected mutations associated with DR in all participants tested, with 93 (88%) having major mutations, including 51 (54%) with dual-class resistance. A history of VF in the prior 2 years (adjusted odds ratio (aOR) 11.1; 95% confidence interval (CI) 6.3, 20.0) and less than 2 years on ART at enrollment (aOR 2.2; 95% CI 1.1, 4.4) were associated with increased odds of major DR. DR is highly prevalent among CHIV on ART with VF in Kenya. Factors associated with drug resistance may be used to determine which children should be prioritized for DRT.
Databáze: MEDLINE
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