XVIII International AIDS Conference

Abstract

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Antiretroviral resistance in HIV-infected children in Guatemala

D. Lau-Bonilla1, B. Samayoa2,3, A. Möller1, M. Ortíz4, L. Rivas1, F. Job5, P. Aparicio5, D. Tatiana5, E. Arathoon6

1Asociación de Salud Integral, Laboratory of Molecular Biology, Guatemala, Guatemala, 2Asociación de Salud Integral, Reseach and Development, Guatemala, Guatemala, 3Universidad de San Carlos de Guatemala, Microbiology, Guatemala, Guatemala, 4Centro Nacional de Microbiología, Biología Molecular, Servicio de Retrovirus y Papilomavirus, Majadahonda, Madrid, Spain, 5Instituto de Salud Carlos III - Ministerio de Ciencia e Inovación, Centro de Medicina Tropical, Madrid, Spain, 6Asociación de Salud Integral, Clínica Familiar 'Luis Angel García', Guatemala, Guatemala

Background: The pediatric cohort has been one of the first with antiretroviral therapy (ART) in Guatemala. Hence, there are several cases of virological failure in this group, even among those children that started ART recently (< 1 year). HIV genotyping testing hasn´t been available for pediatric patients, thus there is no data about the situation of antiretroviral (ARV) resistance for these patients. The aim of this study was to determine the presence of ARV resistance in HIV-infected children in Guatemala. Methods: HIV genotyping tests were performed in 40 plasma samples from HIV-infected children (ages 1-16 years, avg.6.53 years) from 8 health centers located in different regions of Guatemala. The samples were analyzed in the Retrovirus and Papilomavirus Service of the National Center of Microbiology, in Majadahonda, Madrid, Spain.
Results: 97.5% of these children were infected by vertical transmission, 2.5% were infected by sexual abuse or transfusion of blood products. All children had 1 to 4 changes in their ART scheme and 92.5% presented virological failure. HIV-1 sub-type B was found in 100% of the samples. The genotyping data showed that 95% of the samples exhibited some level of resistance to at least one type of ARV, from these, 82.5% of the samples showed some level of resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI), 80% to nucleoside reverse transcriptase inhibitors (NRTI) and 55% to protease inhibitors (PI). Thymidine Analog Mutations (TAMs) were found in 77.5% of the samples. The mutations most commonly found were: I54V, L33F and M46I for PI; M184V, M41L and T215Y for NRTI; and K103N, K103R and V108I for NNRTI.
Conclusions: In this group of HIV-infected children, ARV resistance is a major problem. Genotyping testing for all HIV-infected children must be available from the moment they are diagnosed and especially when they receive ART.


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