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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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