title: High frequency of primary mutations associated with antiretroviral drug resistance in recently diagnosed HIV-infected children.
abstract: BACKGROUND
  The aim of our study was to analyse the frequency of primary mutations associated with HIV drug resistance in a population of children born to HIV-infected mothers.
  
  
  METHODS
  A prospective study included newly HIV-diagnosed children treated at two public paediatric hospitals.
  
  
  METHODS
  Clinical and antiretroviral therapy (ART) data were collected in mother-child pairs. HIV-1 subtyping and ART resistance mutations were assayed in children by sequencing a region of HIV pol gene.
  
  
  RESULTS
  A total of 67 children were enrolled: 22 less than 12 months of age, 20 between 1 and 5 years and 25 between 6 and 14 years. Six (9.0%) children had viral strains with at least one primary mutation associated with resistance to reverse transcriptase and protease inhibitors. A significantly (P = 0.019) higher frequency of resistance (22.7%, n = 5/22) was found among children aged < 12 months. Fourteen children (20.9%) had a subtype B HIV-1 strain and 53 (79.1%) had an inter-subtype B/F recombinant variant.
  
  
  CONCLUSIONS
  A high percentage of recently diagnosed infants were found to carry primary ART resistance mutations. Limited options for ART of HIV-infected children might lead to increased HIV-associated morbidity and mortality. Thus, consideration should be given to mandatory screening for primary ART resistance before initiating therapy for infants aged < 12 months in countries where HIV mother-to-child transmission is still present, such as in Argentina. This will allow for the rationalized and individualized use of drugs and will contribute to the increased cost-effectiveness of local health systems.
authors.affiliation: National Reference Centre for AIDS, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Moira
authors.initials: M
authors.lastname: Vignoles
authors.forename: Graciela
authors.initials: G
authors.lastname: Barboni
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Agosti
authors.forename: Jorge
authors.initials: J
authors.lastname: Quarleri
authors.forename: Mariel Karina
authors.initials: MK
authors.lastname: García
authors.forename: Vera
authors.initials: V
authors.lastname: Giraudi
authors.forename: Silvia González
authors.initials: SG
authors.lastname: Ayala
authors.forename: Horacio
authors.initials: H
authors.lastname: Salomón
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000494:pharmacology*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D006678:HIV / Q000235:genetics*; D015658:HIV Infections / Q000821:virology*; D006801:Humans; D007223:Infant; D008297:Male; D008969:Molecular Sequence Data; D009154:Mutation; D011446:Prospective Studies
chemical_list: D019380:Anti-HIV Agents