AIDS (London, England) 2017 03 15() doi 10.1097/QAD.0000000000001446
We set out to examine the prevalence and persistence of mutations conferring high-level nonnucleoside-reverse-transcriptase (NNRTI)-resistance in a cohort of HIV-infected children who had failed prophylaxis to prevent mother-to-child-transmission (PMTCT).
A prospective observational cohort study at the Pediatric HIV Clinic at Kalafong Provincial Tertiary Hospital in Pretoria, South Africa.
Children referred for initiation of ART were enrolled from July 2010 through February 2013. HIV-drug-resistance testing was performed using the oligonucleotide ligation assay (OLA) on dried blood spots (DBS) collected at enrollment and monthly follow-up visits for two years.
South African children who failed HIV-prophylaxis had a high prevalence of NNRTI-resistant HIV (46/88; 52%). Among children with NNRTI-resistance, the frequency of the predominant resistant variant in each child’s HIV-quasispecies was high (median 96%) at study entry (median age 7.5 months), and in 26/27 followed a median of 13 months persisted at a high frequency (median 89%).
Our finding that infants who fail HIV-prophylaxis frequently have long-lived NNRTI-resistant HIV suggests that resistance will likely persists through 36 months of age, when children qualify for NNRTI-based antiretroviral therapy. These children may benefit from HIV-drug-resistance testing to guide selection of their treatment.