title: High Rates of Drug Resistance Among Newly Diagnosed HIV-infected Children in the National Prevention of Mother-to-child Transmission Program in Togo.
abstract: Prevention of mother-to-child transmission (PMTCT) programs have been largely scaled-up, but data on infant HIV drug resistance from PMTCT programs implemented in resource-limited countries are lacking.
  
  
  
  Remnant dried blood spots from HIV-infected children (aged <18 months) tested through the Togo national early infant diagnosis program during 2012 and 2013 were collected and assessed for HIV drug resistance. Pol-RT (reverse transcriptase) region was amplified, sequenced and analyzed for the presence of drug resistance mutations (DRMs).
  
  
  
  Overall, 121 of 201 (60.2%) newly diagnosed children had detectable DRMs. Among the 131 of 201 (65.2%) children with reported exposure to maternal and/or infant antiretrovirals (ARVs), DRMs were detected in 99 children (75.6%). Importantly, in 41 of 201 children for whom no exposure to ARVs was reported, DRMs were detected in 11 children (26.8%). For 29 children, no data on ARV exposure were available. For the 121 of 201 children with DRMs, 99 of 121 (81.8%) had only nonnucleoside reverse transcriptase inhibitor DRMs detected but 21 of 121 (17.3%) had both nonnucleoside reverse transcriptase inhibitor and nucleoside reverse transcriptase inhibitor (NRTI) DRMs. Among breast-fed children, drug resistance was more frequent when mothers were on antiretroviral therapy (ART), 61 of 75 (81.3%) versus 14 of 39 (35.9%) when mothers were not on ART (P < 0.001). Nucleoside reverse transcriptase inhibitor resistance was more common when mothers were on ART.
  
  
  
  Scale-up and improvement of PMTCT strategies resulted in a global decrease of pediatric HIV infections, but our study shows high rates of drug resistance in infants for whom prevention failed.
authors.affiliation: From the *Laboratoire de Biologie moléculaire et d'immunologie (BIOLIM/FSS/UL) and †Département des sciences fondamentales et biologiques, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo; ‡UMI 233, Institut de Recherche pour le Développement (IRD) and Université de Montpellier, Montpellier, France; §Département de Santé Publique, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo; ¶ISPED, Centre INSERM U897-Epidémiologie-Biostatistique and ‖Inserm U897, ISPED, Université de Bordeaux, Bordeaux, France; **Département de Pédiatrie, Faculté des Sciences de la Santé, Université de Lomé; and ††Programme National de Lutte contre le Sida et les IST/Togo (PNLS/IST/Togo), Lomé, Togo.
authors.forename: Mounerou
authors.initials: M
authors.lastname: Salou
authors.forename: Christelle
authors.initials: C
authors.lastname: Butel
authors.forename: Abla A
authors.initials: AA
authors.lastname: Konou
authors.forename: Didier K
authors.initials: DK
authors.lastname: Ekouevi
authors.forename: Nicole
authors.initials: N
authors.lastname: Vidal
authors.forename: Sika
authors.initials: S
authors.lastname: Dossim
authors.forename: Koko
authors.initials: K
authors.lastname: Lawson-Evi
authors.forename: Yawo T
authors.initials: YT
authors.lastname: Nyasenu
authors.forename: Assetina
authors.initials: A
authors.lastname: Singo-Tokofaï
authors.forename: Senyedji
authors.initials: S
authors.lastname: d'Almeida
authors.forename: Raïssa
authors.initials: R
authors.lastname: Tchama
authors.forename: Eric
authors.initials: E
authors.lastname: Delaporte
authors.forename: Mireille
authors.initials: M
authors.lastname: Prince-David
authors.forename: Martine
authors.initials: M
authors.lastname: Peeters
authors.forename: Anoumou Y
authors.initials: AY
authors.lastname: Dagnra
mesh_terms: D044966:Anti-Retroviral Agents / Q000494:pharmacology*; D003430:Cross-Sectional Studies; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control / Q000706:statistics & numerical data*; D008297:Male; D014037:Togo / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents