HIV drug resistance in African infants and young children newly diagnosed with HIV: a multicounty analysis
Prevention of mother-to-child transmission (PMTCT) of HIV programs have been scaled-up in many low- and middle-income countries; however, HIV drug resistance (HIVDR) data amongst HIV-1-infected young children remain limited
Surveys of pre-treatment HIVDR amongst children younger than 18 months of age who were diagnosed with HIV through Early Infant Diagnosis were conducted in five sub-Saharan African countries (Mozambique, Swaziland, South Africa, Uganda, and Zimbabwe) between 2011 and 2014 following World Health Organization guidance. De-identified demographic and clinical data were used to explore risk factors associated with non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance.
Among the 1,450 genotypes analyzed, 1,048 had accompanying demographic and clinical data. The median age of children was 4 months; 50.4% were female. HIV from 54.1 % showed resistance to one or more antiretroviral drug, with 53.0% and 8.8% having resistance to one or more NNRTI or nucleoside reverse transcriptase inhibitor, respectively. NNRTI resistance was particularly high in children exposed to antiretroviral drugs through PMTCT; adjusted odds ratios 1.8 (95% confidence interval (CI): 1.3 - 2.6) for maternal exposure only and 2.4 (CI: 1.6 - 3.6) for neonatal exposure only.
Protease inhibitor-based regimens in children younger than three years are currently recommended by WHO but the implementation of this recommendation is suboptimal. These results reinforce the urgent need to overcome barriers to scale-up of pediatric protease inhibitor-based regimens in sub-Saharan Africa and underscore the need to accelerate the study and approval of integrase inhibitors for use in young children.