Drug resistance in the HIV-1-infected paediatric population worldwide: a systematic review.
BACKGROUND
Drug resistance monitoring of the paediatric HIV-1-infected population is required to optimize treatment success and preserve future treatment options.


OBJECTIVE
To explore the current knowledge of HIV drug resistance (HIVDR) in naive and pretreated HIV-1-infected paediatric populations across diverse settings and sampling time periods.


METHODS
PubMed database screened until May 2013. We selected publications including data on transmitted (TDR) and acquired drug resistance mutation (DRM) rates and/or pol sequences for HIVDR testing in paediatric patients. We recorded the children's country, age, study period, number of children with pol sequences, presence or absence of antiretroviral treatment (ART) at sampling time, viral region sequenced, HIVDR rate to the three main drug classes (single, double or triple), the considered resistance mutation list and performed assay, specimen type, HIV-1 variants and subtyping methodology when available.


RESULTS
Forty-one selected studies showed HIVDR data from 2538 paediatric HIV-1-infected patients (558 naive and 1980 pretreated) from 30 countries in Africa (11), Asia (6), America (10) and Europe (3). Both TDR and DRM prevalence were reported in 9 studies, only TDR in 6 and only DRM in 26. HIVDR prevalence varied across countries and periods. Most studies used in-house resistance assays using plasma or infected cells. HIV-1 non-B variants were prevalent in 18 paediatric cohorts of the 24 countries with reported subtypes. Only five countries (Uganda, Spain, the UK, Brazil and Thailand) presented resistance data in ≥200 patients.


CONCLUSIONS
Systematic and periodic studies among infected children are crucial to design a more suitable first- or second-line therapy.
HIV-1 Molecular Epidemiology Laboratory, Microbiology Department, Hospital Ramón y Cajal-IRYCIS and CIBERESP, Madrid, Spain.
Patricia
P
Rojas Sánchez
HIV-1 Molecular Epidemiology Laboratory, Microbiology Department, Hospital Ramón y Cajal-IRYCIS and CIBERESP, Madrid, Spain africa.holguin@salud.madrid.org.
Africa
A
Holguín
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D016903:Drug Monitoring; D024921:Drug Resistance, Multiple, Viral / Q000235:genetics*; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D008826:Microbial Sensitivity Tests; D009154:Mutation; D054302:pol Gene Products, Human Immunodeficiency Virus / Q000235:genetics*
D019380:Anti-HIV Agents; D054302:pol Gene Products, Human Immunodeficiency Virus
HIV-1; antiretroviral therapy; children; resistance mutations