Pediatr Infect Dis J

Background: The main objective of this study was to determine the frequency and patterns of HIVDR-associated mutations among children <18 months old born to HIV-1-positive mothers enrolled in the prevention of mother-to-child transmission (PMTCT) services in Haiti. Methods: Between January 1, 2013 and December 31, 2014, HIV-positive remnant dried blood spots (DBS) collected from children under 18 months old for Early Infant Diagnosis (EID) at the National Public Health Laboratory were used for HIV-1 genotyping. HIVDR mutations were analyzed using the Stanford Drug Resistance HIVdb program. Results: Of the 3,555 DBS collected for EID, 360 (10.1%) were HIV-positive and 355 were available for genotyping. Of these, 304 (85.6%) were successfully genotyped and 217 (71.4%) had ≥ one DR mutation. Mutations conferring resistance to NRTIs and NNRTIs were present in 40.5% (123) and 69.1% (210), respectively. The most frequent mutations were K103N/S (48.0%), M184V (37.5%), and G190A/S (15.1%), and Y181C/G/V (14.1%). Predicted drug resistance analysis revealed that 68.8% of the children had high-level resistance to NNRTIs and 11.5% had intermediate to high-level resistance to abacavir. Conclusions: This study showed high rates of resistance to NRTIs and NNRTIs among newly HIV-diagnosed children in Haiti, suggesting that in the era of “option B+” (initiation of lifelong combination antiretroviral therapy to pregnant women with HIV), the majority of children who acquire HIV infection through MTCT have resistant HIV. These results have led the National HIV Program to revise the pediatric guidelines to include protease inhibitors in first-line regimens for all HIV-positive newborns.

30640198

PMC6785839

CDC Public Access