HIV-1 drug resistance among vertically infected children from Rio de Janeiro state, Brazil
J.C. Couto-Fernandez1, S.S.D. Azevedo1, D. Souza2, M.C.L. Rachid3, M.G. Simão2, L.A. Inocêncio2
1Oswaldo Cruz Foundation-FIOCRUZ, Oswaldo Cruz Institute-IOC, Rio de Janeiro, Brazil, 2Brazilian Ministry of Health, Dept. STD, AIDS and Viral Hepatitis, Brasília, Brazil, 3Rio de Janeiro City Health Secretariat, Dept. STD, AIDS and Viral Hepatitis, Rio de Janeiro, Brazil
Background: The Brazilian Ministry of Health made the HIV-1 genotyping test available for infected children, at the start and during antiretroviral therapy (ART). The acknowledgment of the HIV-1 drug resistance is crucial for an efficient suppressive ART response. Thus, we evaluated the prevalence of resistance mutations and HIV-1 subtypes among drug-naïve and children failing ART in the Rio de Janeiro, Brazil.
Methods: The genotyping of HIV-1 drug resistance was performed in the laboratory of the Brazilian Network for HIV-1 Genotyping in Rio de Janeiro. Analysis of resistance mutations and subtype were performed using the Brazilian Algorithm for HIV Resistance Interpretation (www.aids.gov.br/algorithm).
Results: Between 2008 to 2010, 39 drug-naïve and 77 children falling ART from the whole Rio de Janeiro were received for HIV-1 genotyping. The mean age was 4 and 11 years, respectively, in the naïve and treated groups. In the treated group, 32% are using first line and 68% are under second line or salvage ART. The majority of genotyped samples were classified as HIV-1 subtype B (75.8%), followed by subtype F (16.4%) and BF recombinants (3.4 %). The subtype A1 was identified in two subjects, subtype C and A1B recombinant virus were identified in one patient each. Primary drug resistance mutation to reverse transcriptase inhibitors (RTIs) was detected in 10.25% of the ART-naïve children. Among the patients failing ART, 43% shown complete resistance to the nucleoside RTIs, 61% to non-nucleoside RTIs and 39% to the protease inhibitors (PIs).
Conclusions: A significant proportion of drug-naive children presenting resistance mutations to RTIs. A higher prevalence of mutations were observed in children failing ART, both to RTIs and PIs. The persistence of resistance mutations to different class of drugs, support the importance of the genotyping test to optimize the choice of ART, both for the first line and for salvage therapy.
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