title: Drug resistance among drug-naive and first-line antiretroviral treatment-failing children in Cameroon.
abstract: BACKGROUND
  Scale-up to antiretroviral therapy (ART) requires surveillance for HIV drug resistance. With the goal of attaining 100% pediatric ART coverage in Cameroon, strategies to limit the spread of HIV resistance among children are very important.
  
  
  METHODS
  From June 2009 through February 2011, 92 HIV-1-infected children (41 ART-naive, 51 failing first-line ART) living in Yaoundé, Cameroon, were enrolled; HIV-1 Prot-RT genotypic resistance testing (GRT) was performed using an inhouse assay. Among 40 children failing first-line ART, treatment response was evaluated at weeks 24 and 48 after treatment was changed, based on GRT results.
  
  
  RESULTS
  The mean age was 72 months both for children who were drug-naive and those failing ART (range: 3-144 and 12-144, respectively), with a mean viremia of 5.59 log and 4.71 log RNA copies/mL, a median CD4 of 17% (588 cells/μL) and 23% (719 cells/μL), respectively. Median time-to-treatment failure was 610 days. A prevalence of 4.9% and 90% drug resistance was observed, respectively, among children who were drug-naive and those failing first-line ART, with circulating recombinant form CRF02_AG as the most prevalent clade (58.6% and 62%, respectively). After a change to GRT-based treatment, more than 90% of children had viremia <3 log RNA copies/mL at week 24 and confirmed at week 48, with 70% achieving undetectable viremia, although without correlation to immune response; 97.5% had switched to lopinavir/ritonavir-containing regimens.
  
  
  CONCLUSIONS
  HIV-1 drug resistance was low among ART-naive children and very high among those failing first-line ART. Treatment change based on GRT was successful for most children, with lopinavir/ritonavir regimens being very promising for second-line use.
authors.affiliation: Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon. joseph.fokam@circb-cameroun.org
authors.forename: Joseph
authors.initials: J
authors.lastname: Fokam
authors.forename: Romina
authors.initials: R
authors.lastname: Salpini
authors.forename: Maria Mercedes
authors.initials: MM
authors.lastname: Santoro
authors.forename: Valeria
authors.initials: V
authors.lastname: Cento
authors.forename: Carlo-Federico
authors.initials: CF
authors.lastname: Perno
authors.forename: Vittorio
authors.initials: V
authors.lastname: Colizzi
authors.forename: Peter Martins
authors.initials: PM
authors.lastname: Ndumbe
authors.forename: Charles
authors.initials: C
authors.lastname: Fokunang Ntungen
authors.forename: Suzie Moyo
authors.initials: SM
authors.lastname: Ndiang Tetang
authors.forename: Aubin Joseph
authors.initials: AJ
authors.lastname: Nanfack
authors.forename: Désiré Augustin
authors.initials: DA
authors.lastname: Takou Komego
authors.forename: Giulia
authors.initials: G
authors.lastname: Cappelli
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002163:Cameroon / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D010802:Phylogeny; D015995:Prevalence; D011446:Prospective Studies; D017211:Treatment Failure
chemical_list: D019380:Anti-HIV Agents