{"id":28099,"date":"2015-03-24T09:11:15","date_gmt":"2015-03-24T09:11:15","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=28099"},"modified":"2015-03-25T08:07:14","modified_gmt":"2015-03-25T08:07:14","slug":"drug-resistance-in-children-after-pmtct-and-early-treatment","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/28099","title":{"rendered":"Drug resistance in children after PMTCT and early treatment"},"content":{"rendered":"

\"HDRWSimon Collins, HIV i-Base<\/strong><\/p>\n

With fewer treatment options, especially in resource-limited settings, two studies were notable for highlighting the high rates of drug resistance in young children and that this is often compounded by transmitted resistance.<\/strong><\/p>\n

Resistance test results were presented for a cohort of children in Burkino Faso and C\u00f4te d’Ivoire aged < 2 years who were enrolled from September 2011 to January 2013 on first-line lopinavir\/ritonavir based combinations, whose treatment was failing (defined as viral load >1000 copies\/mL at 12 months). [1]<\/p>\n

Of 156 children enrolled, 28 (18%) had virologic failure. Median viral load was 5 million copies\/mL (range 4.4 to 8.2 log copies\/mL). All samples were amplified and 21\/28 (75%) had resistance to at least one drug. Among those, 11\/21 (52%) were primary mutations acquired during therapy and 5 (25%) attributed to PMTCT intervention. The most common mutations were M184 (57%), K103N (18%), Y181C (11%) and E138G (3.6%). One sample had 3-class resistance to NRTI, NNRTI and PI.<\/p>\n

The impact of ARV exposure as part of PMTCT on drug resistance in children who became infected was reported in a cohort of children from Mozambique. Results were from dry blood spot samples that had formed their initial diagnosis.<\/p>\n

Of 496 samples collected, 429 (86%) were successfully genotyped, 97% were subtype C.<\/p>\n

NNRTI resistance (Y181C, E138A and G190A) was present in 52.9% and NRTI resistance in 11.4% (mainly M184V). Maternal use of ART was significantly associated with NRTI resistance, (OR 2.41; p< 0.05).<\/p>\n

Comment<\/h3>\n

A poster from the ARROW study at CROI 2014, <\/strong>[3] joins other studies in older children <\/strong>[4, 5] that suggest perinatally acquired resistance from nevirapine exposure might not necessarily translate into poor response to nevirapine-based treatment.<\/strong><\/p>\n

References:<\/p>\n

Unless stated otherwise, references are to the Programme and Abstracts of the XXIV International HIV Drug Resistance Workshop, 21-22 February 2015, Seattle, Washington.<\/p>\n

    \n
  1. Toni TA et al. Virologic failure and profiles of resistance after 12 months of antiretroviral lopinavir-based therapy in children early treated before the age of two, in West Africa. Abstract 33.<\/li>\n
  2. Ismael N et al. Primary drug resistance among children infected with HIV-1 in Mozambique: impact of maternal and neonatal prophylaxis. Abstract 78.<\/li>\n
  3. Musoke P et al. SdNVP exposure and ART response in children <3 years initiating ART in the ARROW trial. CROI, March 3-6, 2014, Boston. Poster abstract 894.
    \nhttp:\/\/www.croiconference.org\/sessions\/sdnvp-exposure-and-art-response-children<\/a><\/li>\n
  4. Lindsey JC et al. Predictors of virologic and clinical response to nevirapine versus lopinavir\/ritonavir-based antiretroviral therapy in young children with and without prior nevirapine exposure for the prevention of mother-to-child HIV iransmission. The Pediatric Infectious Disease Journal 2014 (33):846-854.<\/li>\n
  5. Musoke P et al. Response to antiretroviral therapy in HIV-infected Ugandan children exposed and not exposed to single-dose nevirapine at birth. Journal of AIDS 2009 (52):560-568.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Simon Collins, HIV i-Base With fewer treatment options, especially in resource-limited settings, two studies were notable for highlighting the high rates of drug resistance in young children and that this is often compounded by transmitted resistance. Resistance test results were …<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,35,32,36],"tags":[202],"class_list":["post-28099","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-pmtct-and-maternal-health","category-paediatric-care","category-drug-resistance","tag-intl-drug-resistance-workshop-24-seattle-2015"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/28099","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=28099"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/28099\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=28099"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=28099"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=28099"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}