title: Development of antiretroviral resistance in children with HIV in low- and middle-income countries.
abstract: With antiretroviral therapy (ART) recommended by the World Health Organization (WHO) for children aged <2 years with human immunodeficiency virus (HIV) and continuing global ART roll-out, ART coverage in children is rising. However ART coverage in children lags considerably behind that in adults (28% vs 58%). Long duration of therapy needed for HIV-infected children requires maximal efficacy, minimal toxicity, and prevention of development of drug resistance. This requires consideration of ways to improve sequencing of regimens during childhood to minimize development of resistance and treatment failure. We consider aspects of virological failure and development of resistance in vertically HIV-infected children in resource-limited settings. We review evidence guiding choices of first- and second-line ART, the impact of drugs given to prevent mother-to-child transmission, adherence issues and, availability of appropriate drug formulations. Recommendations made during the Collaborative HIV and Anti-HIV Drug Resistance Network (CHAIN)/WHO meeting (October 2012) are summarized.
authors.affiliation: North Middlesex University Hospital Trust, Sterling Way, London, UK. felicity.fitzgerald@nhs.net
authors.forename: Felicity
authors.initials: F
authors.lastname: Fitzgerald
authors.forename: Martina
authors.initials: M
authors.lastname: Penazzato
authors.forename: Diana
authors.initials: D
authors.lastname: Gibb
mesh_terms: D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D024882:Drug Resistance, Viral; D004359:Drug Therapy, Combination; D006678:HIV / Q000187:drug effects* / Q000235:genetics / Q000502:physiology; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000635:transmission / Q000821:virology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D009154:Mutation; D011203:Poverty; D015995:Prevalence; D012367:RNA, Viral / Q000235:genetics; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors
keywords: HIV; antiretroviral therapy; children; mother-to-child transmission; resistance