title: High rates of virological failure and drug resistance in perinatally HIV-1-infected children and adolescents receiving lifelong antiretroviral therapy in routine clinics in Togo.
abstract: BACKGROUND
  Antiretroviral treatment (ART) has been scaled up over the last decade but compared to adults, children living with HIV are less likely to receive ART. Moreover, children and adolescents are more vulnerable than adults to virological failure (VF) and emergence of drug resistance. In this study we determined virological outcome in perinatally HIV-1-infected children and adolescents receiving ART in Togo.
  
  
  METHODS
  HIV viral load (VL) testing was consecutively proposed to all children and adolescents who were on ART for at least 12 months when attending HIV healthcare services for their routine follow-up visit (June to September 2014). Plasma HIV-1 VL was measured using the m2000 RealTime HIV-1 assay (Abbott Molecular, Des Plaines, IL, USA). Genotypic drug resistance was done for all samples with VL>1000 copies/ml.
  
  
  CONCLUSIONS
  Among 283 perinatally HIV-1-infected children and adolescents included, 167 (59%) were adolescents and 116 (41%) were children. The median duration on ART was 48 months (interquartile range: 28 to 68 months). For 228 (80.6%), the current ART combination consisted of two nucleoside reverse transcriptase inhibitors (NRTIs) (zidovudine and lamivudine) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) (nevirapine or efavirenz). Only 28 (9.9%) were on a protease inhibitor (PI)-based regimen. VL was below the detection limit (i.e. 40 copies/ml) for 102 (36%), between 40 and 1000 copies/ml for 35 (12.4%) and above 1000 copies/ml for 146 (51.6%). Genotypic drug-resistance testing was successful for 125/146 (85.6%); 110/125 (88.0%) were resistant to both NRTIs and NNRTIs, 1/125 (0.8%) to NRTIs only, 4/125 (3.2%) to NNRTIs only and three harboured viruses resistant to reverse transcriptase and PIs. Overall, 86% (108/125) of children and adolescents experiencing VF and successfully genotyped, corresponding thus to at least 38% of the study population, had either no effective ART or had only a single effective drug in their current ART regimen.
  
  
  CONCLUSIONS
  Our study provided important information on virological outcome on lifelong ART in perinatally HIV-1-infected children and adolescents who were still on ART and continued to attend antiretroviral (ARV) clinics for follow-up visits. Actual conditions for scaling up and monitoring lifelong ART in children in resource-limited countries can have dramatic long-term outcomes and illustrate that paediatric ART receives inadequate attention.
authors.affiliation: Laboratoire de Biologie Moléculaire et d'Immunologie, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.
authors.forename: Mounerou
authors.initials: M
authors.lastname: Salou
authors.affiliation: Laboratoire de Biologie Moléculaire et d'Immunologie, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.
authors.forename: Anoumou Y
authors.initials: AY
authors.lastname: Dagnra
authors.affiliation: UMI 233, Institut de Recherche pour le Développement, INSERM U1175, Université de Montpellier, Montpellier, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Butel
authors.affiliation: UMI 233, Institut de Recherche pour le Développement, INSERM U1175, Université de Montpellier, Montpellier, France.
authors.forename: Nicole
authors.initials: N
authors.lastname: Vidal
authors.affiliation: UMI 233, Institut de Recherche pour le Développement, INSERM U1175, Université de Montpellier, Montpellier, France.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Serrano
authors.affiliation: Service de Pédiatrie CHU Sylvanus Olympio, Lomé, Togo.
authors.forename: Elom
authors.initials: E
authors.lastname: Takassi
authors.affiliation: Laboratoire de Biologie Moléculaire et d'Immunologie, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.
authors.forename: Abla A
authors.initials: AA
authors.lastname: Konou
authors.affiliation: Association Espoir pour Demain, Kara, Togo.
authors.forename: Spero
authors.initials: S
authors.lastname: Houndenou
authors.affiliation: Espoir Vie Togo, Lomé, Togo.
authors.forename: Nina
authors.initials: N
authors.lastname: Dapam
authors.affiliation: Programme National de Lutte contre le Sida et les IST/Togo, Lomé, Togo.
authors.forename: Assetina
authors.initials: A
authors.lastname: Singo-Tokofaï
authors.affiliation: Conseil National de Lutte contre le SIDA and Faculté des Sciences de la Santé, Lomé, Togo.
authors.forename: Palokinam
authors.initials: P
authors.lastname: Pitche
authors.affiliation: Service de Pédiatrie CHU Sylvanus Olympio, Lomé, Togo.|Département de Pédiatrie, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.
authors.forename: Yao
authors.initials: Y
authors.lastname: Atakouma
authors.affiliation: Laboratoire de Biologie Moléculaire et d'Immunologie, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.
authors.forename: Mireille
authors.initials: M
authors.lastname: Prince-David
authors.affiliation: UMI 233, Institut de Recherche pour le Développement, INSERM U1175, Université de Montpellier, Montpellier, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Delaporte
authors.affiliation: UMI 233, Institut de Recherche pour le Développement, INSERM U1175, Université de Montpellier, Montpellier, France; martine.peeters@ird.fr.
authors.forename: Martine
authors.initials: M
authors.lastname: Peeters
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D014037:Togo; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: Africa; HIV; Togo; antiretroviral treatment; children; drug resistance; virological failure