Mounerou Salou1, Christelle Butel, Abla A Konou, Didier K Ekouevi, Nicole Vidal, Sika Dossim, Koko Lawson-Evi, Yawo T Nyasenu, Assetina Singo-Tokofaï, Senyedji d'Almeida, Raïssa Tchama, Eric Delaporte, Mireille Prince-David, Martine Peeters, Anoumou Y Dagnra. 1. From the *Laboratoire de Biologie moléculaire et d'immunologie (BIOLIM/FSS/UL) and †Département des sciences fondamentales et biologiques, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo; ‡UMI 233, Institut de Recherche pour le Développement (IRD) and Université de Montpellier, Montpellier, France; §Département de Santé Publique, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo; ¶ISPED, Centre INSERM U897-Epidémiologie-Biostatistique and ‖Inserm U897, ISPED, Université de Bordeaux, Bordeaux, France; **Département de Pédiatrie, Faculté des Sciences de la Santé, Université de Lomé; and ††Programme National de Lutte contre le Sida et les IST/Togo (PNLS/IST/Togo), Lomé, Togo.
Abstract
BACKGROUND: Prevention of mother-to-child transmission (PMTCT) programs have been largely scaled-up, but data on infant HIV drug resistance from PMTCT programs implemented in resource-limited countries are lacking. METHODS: Remnant dried blood spots from HIV-infected children (aged <18 months) tested through the Togo national early infant diagnosis program during 2012 and 2013 were collected and assessed for HIV drug resistance. Pol-RT (reverse transcriptase) region was amplified, sequenced and analyzed for the presence of drug resistance mutations (DRMs). RESULTS: Overall, 121 of 201 (60.2%) newly diagnosed children had detectable DRMs. Among the 131 of 201 (65.2%) children with reported exposure to maternal and/or infant antiretrovirals (ARVs), DRMs were detected in 99 children (75.6%). Importantly, in 41 of 201 children for whom no exposure to ARVs was reported, DRMs were detected in 11 children (26.8%). For 29 children, no data on ARV exposure were available. For the 121 of 201 children with DRMs, 99 of 121 (81.8%) had only nonnucleoside reverse transcriptase inhibitor DRMs detected but 21 of 121 (17.3%) had both nonnucleoside reverse transcriptase inhibitor and nucleoside reverse transcriptase inhibitor (NRTI) DRMs. Among breast-fed children, drug resistance was more frequent when mothers were on antiretroviral therapy (ART), 61 of 75 (81.3%) versus 14 of 39 (35.9%) when mothers were not on ART (P < 0.001). Nucleoside reverse transcriptase inhibitor resistance was more common when mothers were on ART. CONCLUSIONS: Scale-up and improvement of PMTCT strategies resulted in a global decrease of pediatric HIV infections, but our study shows high rates of drug resistance in infants for whom prevention failed.
BACKGROUND: Prevention of mother-to-child transmission (PMTCT) programs have been largely scaled-up, but data on infant HIV drug resistance from PMTCT programs implemented in resource-limited countries are lacking. METHODS: Remnant dried blood spots from HIV-infectedchildren (aged <18 months) tested through the Togo national early infant diagnosis program during 2012 and 2013 were collected and assessed for HIV drug resistance. Pol-RT (reverse transcriptase) region was amplified, sequenced and analyzed for the presence of drug resistance mutations (DRMs). RESULTS: Overall, 121 of 201 (60.2%) newly diagnosed children had detectable DRMs. Among the 131 of 201 (65.2%) children with reported exposure to maternal and/or infant antiretrovirals (ARVs), DRMs were detected in 99 children (75.6%). Importantly, in 41 of 201 children for whom no exposure to ARVs was reported, DRMs were detected in 11 children (26.8%). For 29 children, no data on ARV exposure were available. For the 121 of 201 children with DRMs, 99 of 121 (81.8%) had only nonnucleoside reverse transcriptase inhibitor DRMs detected but 21 of 121 (17.3%) had both nonnucleoside reverse transcriptase inhibitor and nucleoside reverse transcriptase inhibitor (NRTI) DRMs. Among breast-fed children, drug resistance was more frequent when mothers were on antiretroviral therapy (ART), 61 of 75 (81.3%) versus 14 of 39 (35.9%) when mothers were not on ART (P < 0.001). Nucleoside reverse transcriptase inhibitor resistance was more common when mothers were on ART. CONCLUSIONS: Scale-up and improvement of PMTCT strategies resulted in a global decrease of pediatric HIV infections, but our study shows high rates of drug resistance in infants for whom prevention failed.
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