title: Drug resistance prevalence in human immunodeficiency virus type 1 infected pediatric populations in Honduras and El Salvador during 1989-2009.
abstract: BACKGROUND
  Emergence of viral resistance is a major obstacle for antiretroviral treatment (ART) effectiveness. Human immunodeficiency virus type-1 (HIV-1) variants and drug-resistance mutations were identified in naive and antiretroviral drug-experienced children with virologic failure, in Honduras and El Salvador.
  
  
  METHODS
  Dried blood spots (DBS) from 80 individuals (54 from Honduras, 26 from El Salvador) infected during their childhood between 1989 and 2009 were collected in 2009. The HIV pol region was amplified and sequenced to identify antiretroviral-resistant mutations according to the 2009 International AIDS Society. The genotypic drug resistance interpretation was performed using the Stanford algorithm. HIV-1 variants were characterized by phylogenetic analysis and subtyping tools.
  
  
  RESULTS
  HIV-1 protease and reverse transcription sequences were obtained from DBS specimens in 71 and 66 patients, respectively, of the 80 patients. All children were native Central Americans carrying subtype B, with a mean age of 9 years, most were male (65%), perinatally infected (96%), with moderate/severe AIDS symptoms (70%), and receiving first line ART at the time of sequencing (65%). Diagnostic delay was frequently observed. Infected children from Honduras presented longer ART experience and clinical outcomes, and more frequent severe symptoms. Resistant variants infected 1 of 11 naive children from El Salvador but none of the perinatally infected naive children from Honduras. Resistance was higher among ART-exposed individuals in both countries and similar for protease inhibitors (16%), nucleoside reverse transcription inhibitors (44%-52%), and nonnucleoside reverse-transcription inhibitors (66.7%). One in 10 pretreated children in each country was infected with resistant viruses to the 3 drug families.
  
  
  CONCLUSIONS
  Our data support the need for continued surveillance of resistance patterns using DBS at national levels among naive and pretreated children to optimize the ART regimens.
authors.affiliation: HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology and Parasitology, FiBIO-IRYCIS (Hospital Ramón y Cajal) and CIBER-ESP, Madrid, Spain. aholguin.hciii@salud.madrid.org
authors.forename: Africa
authors.initials: A
authors.lastname: Holguín
authors.forename: Karen
authors.initials: K
authors.lastname: Erazo
authors.forename: Gustavo
authors.initials: G
authors.lastname: Escobar
authors.forename: Miguel
authors.initials: M
authors.lastname: de Mulder
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Yebra
authors.forename: Leticia
authors.initials: L
authors.lastname: Martín
authors.forename: Luis Enrique
authors.initials: LE
authors.lastname: Jovel
authors.forename: Luis
authors.initials: L
authors.lastname: Castaneda
authors.forename: Elsy
authors.initials: E
authors.lastname: Pérez
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000494:pharmacology*; D001769:Blood / Q000821:virology; D002648:Child; D002675:Child, Preschool; D024882:Drug Resistance, Viral; D004544:El Salvador / Q000453:epidemiology; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects* / Q000302:isolation & purification; D006721:Honduras / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020125:Mutation, Missense; D015995:Prevalence; D012367:RNA, Viral / Q000235:genetics; D017422:Sequence Analysis, DNA; D017211:Treatment Failure; D054302:pol Gene Products, Human Immunodeficiency Virus / Q000235:genetics
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral; D054302:pol Gene Products, Human Immunodeficiency Virus