Resistance is common in paediatric patients failing ART in South Africa

Details

• Alternative Title:
  J Antimicrob Chemother
• Personal Author:
  Hunt, Gillian M. ; Yousif, Mukhlid ; Levin, Leon ; Ledwaba, Johanna ; Steegen, Kim ; Kufa, Tendesayi ; Zwane, Hloniphile ; Kalimashe, Monalisa ; Kana, Vibha ; Aynalem, Getahun ; Perlman, Jaclyn ; Ayalew, Kassahun ; Kindra, Gurpreet ; Diallo, Karidia ; Carmona, Sergio ; Sherman, Gayle ; Raizes, Elliot J.
• Description:
  Background:
  
  Minimal data exist on HIV drug resistance patterns and prevalence among paediatric patients failing ART in resource-limited settings. We assessed levels of HIV drug resistance in children with virological failure.
  
  Methods:
  
  This cross-sectional study, performed from March 2017 to March 2019 in South Africa, enrolled HIV-positive children aged ≤19 years, receiving ART through public health facilities with recent evidence suggestive of virological failure (at least one viral load ≥1000 copies/mL), across 45 randomly selected high-volume clinics from all nine provinces. Resistance genotyping was performed using next-generation sequencing technologies. Descriptive analysis taking into account survey design was used to determine outcomes.
  
  Results:
  
  Among 899 participants enrolled, the adjusted proportion of HIV drug resistance among children with virological failure was 87.5% (95% CI 83.0%–90.9%). Resistance to NNRTIs was detected in 77.4% (95% CI 72.5%–81.7%) of participants, and resistance to NRTIs in 69.5% (95% CI 62.9%–75.4%) of participants. Overall, resistance to PIs was detected in 7.7% (95% CI 4.4%–13.0%) of children.
  
  Conclusions:
  
  HIV drug resistance was highly prevalent in paediatric patients failing ART in South Africa, with 9 in 10 patients harbouring resistance to NNRTIs and/or NRTIs. PI-based regimens are predicted to be highly efficacious in achieving virological suppression amongst patients failing NNRTI-based regimens. Scaling up resistance testing amongst patients would facilitate access to second- and third-line regimens in South Africa.
  
  
• Keywords:
  Anti-HIV Agents Child Cross-Sectional Studies Drug Resistance, Viral HIV Infections Humans South Africa Treatment Failure Viral Load
• Source:
  J Antimicrob Chemother. 78(5):1160-1167
• Pubmed ID:
  37017009
• Pubmed Central ID:
  PMC10616358
• Document Type:
  Journal Article
• Funding:
  U2G GH001631/GH/CGH CDC HHSUnited States/ ; PEPFAR/PEPFARUnited States/
• Volume:
  78
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:e564347729789adabd64b69a911c327a5ccfa46cf6268d1fa9d91bafe952572a
• Download URL:
  https://stacks.cdc.gov/view/cdc/134768/cdc_134768_DS1.pdf
• File Type:
  [PDF - 221.35 KB ]