title: HIV-1 drug mutations in children from northern Tanzania.
abstract: OBJECTIVE
  In resource-limited settings, it is a challenge to get quality clinical specimens due to poor infrastructure for their collection, transportation, processing and storage. Using dried blood spots (DBS) might be an alternative to plasma for HIV-1 drug resistance testing in this setting. The objectives of this study were to determine mutations associated with antiretroviral resistance among children <18 months old born to HIV-1-infected mothers enrolled in prevention of mother-to-child transmission services in northern Tanzania.
  
  
  METHODS
  Kilimanjaro Christian Medical Center (KCMC) Clinical Laboratory is the zonal centre for early infant diagnosis using DBS in northern Tanzania. DBS were collected from January 2011 to December 2012. Mothers were kept on triple therapy and single-dose nevirapine before pregnancy and during labour, respectively. Infants were given single-dose nevirapine and most of them were breastfed. Genotypic resistance was determined in those with a viral load of >400 copies/mL.
  
  
  RESULTS
  Genotypic resistance mutations were detected in 13 of 46 children (28%). HIV-1 genotypes were A1 (n = 27), C (n = 10), A/D (n = 4), D (n = 3) and CRF10_CD (n = 2). The median age was 12 weeks (IQR 6-28). The mean log10 viral load was 3.87 copies/mL (SD 0.995). All major mutations were detected in the reverse transcriptase gene and none in the protease gene region. The most frequent mutations were Y181C (n = 8) and K103N (n = 4), conferring resistance to non-nucleoside reverse transcriptase inhibitors.
  
  
  CONCLUSIONS
  One-third of infants newly diagnosed with HIV in northern Tanzania harboured major drug resistance mutations to currently used antiretroviral regimens. These mutations were detected from DBS collected from the field and stored at room temperature. Surveillance of drug resistance among this population in resource-limited settings is warranted.
authors.affiliation: Kilimanjaro Christian Medical Center, Moshi, Tanzania Kilimanjaro Christian Medical University College, Moshi, Tanzania Kilimanjaro Clinical Research Institute, Moshi, Tanzania elichilia2004@yahoo.co.uk.
authors.forename: Elichilia R
authors.initials: ER
authors.lastname: Shao
authors.affiliation: Kilimanjaro Christian Medical Center, Moshi, Tanzania.
authors.forename: Emmanuel G
authors.initials: EG
authors.lastname: Kifaro
authors.affiliation: Kilimanjaro Christian Medical Center, Moshi, Tanzania.
authors.forename: Innocent B
authors.initials: IB
authors.lastname: Chilumba
authors.affiliation: Kilimanjaro Christian Medical Center, Moshi, Tanzania Kilimanjaro Christian Medical University College, Moshi, Tanzania Kilimanjaro Clinical Research Institute, Moshi, Tanzania.
authors.forename: Balthazar M
authors.initials: BM
authors.lastname: Nyombi
authors.affiliation: Botswana Harvard HIV Research Laboratory, Gaborone, Botswana.
authors.forename: Sikhulile
authors.initials: S
authors.lastname: Moyo
authors.affiliation: Botswana Harvard HIV Research Laboratory, Gaborone, Botswana.
authors.forename: Simani
authors.initials: S
authors.lastname: Gaseitsiwe
authors.affiliation: Botswana Harvard HIV Research Laboratory, Gaborone, Botswana.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Musonda
authors.affiliation: Vestre Viken HF Drammen Hospital, Drammen, Norway.
authors.forename: Asgeir
authors.initials: A
authors.lastname: Johannessen
authors.affiliation: Kilimanjaro Christian Medical Center, Moshi, Tanzania Kilimanjaro Christian Medical University College, Moshi, Tanzania Kilimanjaro Clinical Research Institute, Moshi, Tanzania.
authors.forename: Gibson
authors.initials: G
authors.lastname: Kibiki
authors.affiliation: Botswana Harvard HIV Research Laboratory, Gaborone, Botswana.
authors.forename: Max
authors.initials: M
authors.lastname: Essex
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use; D024882:Drug Resistance, Viral; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D008969:Molecular Sequence Data; D020125:Mutation, Missense; D011247:Pregnancy; D017422:Sequence Analysis, DNA; D013636:Tanzania
chemical_list: D019380:Anti-HIV Agents
keywords: antiretroviral therapy; child; dried blood spots; early infant diagnosis; mutations; sub-Saharan Africa
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