title: Virological suppression in children and adolescents is not influenced by genotyping, but depends on optimal adherence to antiretroviral therapy.
abstract: OBJECTIVE
  To evaluate the virological outcomes in children and adolescents infected with HIV-1 in Salvador, Bahia according to genotyping results.
  
  
  METHODS
  We retrospectively evaluated the rates of virological suppression of children and adolescents submitted to HIV-1 genotyping test from January/2008 to December/2012. The participants were followed in the two referral centers for pediatric AIDS care, in Salvador, Brazil. Resistance mutations, drug sensitivity profiles, and viral subtypes were analyzed using the Stanford HIV-1 Drug Resistance Database. Adherence was estimated by drugs withdrawal at pharmacies of the two sites.
  
  
  RESULTS
  101 subjects were included: 35 (34.6%) were drug-naïve, and the remaining 66 were failing ART. In drug-naïve group, 3 (8.6%), presented with NNRTIs resistance mutations, along with polymorphic mutations to PIs in most (82.8%) of them. Among the failing therapy group, we detected a high frequency (89.4%) of resistance mutations to PIs, NRTI (84.8%), and NNRTI (59.1%). Virological suppression after introduction/modification of genotyping-guided ART was achieved only for patients (53.1%) with drug withdrawal over 95%. Main detected HIV-1 subtypes were B (67.3%), F (7.9), C (1.9%), and recombinant forms (22.9%).
  
  
  CONCLUSIONS
  Despite the use of genotyping tests in guidance of a more effective antiretroviral regimen, poor adherence to ART seems to be the main determinant of low virological suppression rate for children and adolescents, in Salvador, Brazil.
authors.affiliation: Universidade Federal da Bahia, Laboratótio de Retrovirologia, Salvador, BA, Brazil.
authors.forename: Juliana Costa de
authors.initials: JC
authors.lastname: Abreu
authors.affiliation: Universidade Federal da Bahia, Laboratótio de Retrovirologia, Salvador, BA, Brazil.
authors.forename: Sara Nunes
authors.initials: SN
authors.lastname: Vaz
authors.affiliation: Universidade Federal da Bahia, Laboratótio de Retrovirologia, Salvador, BA, Brazil.
authors.forename: Eduardo Martins
authors.initials: EM
authors.lastname: Netto
authors.affiliation: Universidade Federal da Bahia, Laboratótio de Retrovirologia, Salvador, BA, Brazil. Electronic address: crbrites@gmail.com.
authors.forename: Carlos
authors.initials: C
authors.lastname: Brites
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000235:genetics*; D006801:Humans; D007223:Infant; D008297:Male; D055118:Medication Adherence; D009154:Mutation; D012189:Retrospective Studies; D019562:Viral Load / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents
keywords: Adherence; Children; Genotyping; Virological suppression