title: Genotype-guided antiretroviral regimens in children with multidrug-resistant HIV-1 infection.
abstract: Genotyping tests were developed to attenuate the impact of viral resistance. Information about the efficacy in genotype base antiretroviral therapy in children is rare and even more in low- and middle-income countries.
  
  
  
  Sixteen children with antiretroviral therapy (ART) failure and triple-class drug-resistant viruses were included in this study. Protease and retrotranscriptase genotypes were available for all patients. Switch of ART regimen was guided by genotyping data. The primary end point was virological suppression (<50 copies/ml) and immunological improvement after 48 wk of treatment with the new ART regimen.
  
  
  
  The median age of the patients was 14.5 y (interquartile range (IQR) 11-16.5). Median HIV-1 RNA viral load was 4.2 log10 (IQR: 3.4-4.8). The primary end point was found in 11 children (69%), and 13 children (81%) had an HIV-1 RNA viral load <200 copies/ml. Median (IQR) for the baseline CD4(+) cell count was 382 cells/μl (281-686 cells/μl), whereas after 48 wk of treatment with the new ART regimen, it was 640 cells/μl (361-936 cells/μl) (P < 0.001).
  
  
  
  Darunavir/ritonavir, raltegravir, and etravirine were well tolerated in the present pediatric population. These drugs provide good options for children exposed to extensive ART. Regimens guided by genotyping data were effective for children who had ART failure and multidrug-resistant HIV-1 infection.
authors.affiliation: Pediatric Infectious Disease Department, Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", IMSS, Ciudad de Mexico, México.
authors.forename: Gloria
authors.initials: G
authors.lastname: Huerta-García
authors.affiliation: Pediatric Infectious Disease Department, Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", IMSS, Ciudad de Mexico, México.
authors.forename: José G
authors.initials: JG
authors.lastname: Vazquez-Rosales
authors.affiliation: Infectious Diseases Department, Hospital de Infectología, National Medical Center "La Raza", IMSS, Ciudad de Mexico, México.
authors.forename: José A
authors.initials: JA
authors.lastname: Mata-Marín
authors.affiliation: Pediatric Infectious Disease Department, Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", IMSS, Ciudad de Mexico, México.
authors.forename: Leoncio
authors.initials: L
authors.lastname: Peregrino-Bejarano
authors.affiliation: Pediatric Infectious Disease Department, Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", IMSS, Ciudad de Mexico, México.
authors.forename: Eric
authors.initials: E
authors.lastname: Flores-Ruiz
authors.affiliation: Unidad Médica de Alta Especialidad, Hospital de Pediatría, National Medical Center "Siglo XXI", IMSS, Ciudad de Mexico, México.
authors.forename: Fortino
authors.initials: F
authors.lastname: Solórzano-Santos
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002648:Child; D000069454:Darunavir / Q000627:therapeutic use; D024921:Drug Resistance, Multiple, Viral; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D008297:Male; D009570:Nitriles; D011203:Poverty; D011724:Pyridazines / Q000627:therapeutic use; D011743:Pyrimidines; D012367:RNA, Viral / Q000032:analysis; D000068898:Raltegravir Potassium / Q000627:therapeutic use; D012189:Retrospective Studies; D019438:Ritonavir / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents; D009570:Nitriles; D011724:Pyridazines; D011743:Pyrimidines; D012367:RNA, Viral; C451734:etravirine; D000068898:Raltegravir Potassium; D019438:Ritonavir; D000069454:Darunavir