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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e31822db54c
Pediatric HIV/AIDS

Drug Resistance Among Drug-naive and First-line Antiretroviral Treatment-failing Children in Cameroon

Fokam, Joseph MSc*,†; Salpini, Romina MSc; Santoro, Maria Mercedes PhD; Cento, Valeria MSc; Perno, Carlo-Federico MD, PhD‡,§; Colizzi, Vittorio MD, PhD*,¶; Ndumbe, Peter Martins MD, PhD*,†,‖; Fokunang Ntungen, Charles PhD; Ndiang Tetang, Suzie Moyo MD**; Nanfack, Aubin Joseph MSc*; Takou Komego, Désiré Augustin MSc*; Cappelli, Giulia PhD*,††

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Abstract

Background: Scale-up to antiretroviral therapy (ART) requires surveillance for HIV drug resistance. With the goal of attaining 100% pediatric ART coverage in Cameroon, strategies to limit the spread of HIV resistance among children are very important.

Methods: From June 2009 through February 2011, 92 HIV-1-infected children (41 ART-naive, 51 failing first-line ART) living in Yaoundé, Cameroon, were enrolled; HIV-1 Prot-RT genotypic resistance testing (GRT) was performed using an inhouse assay. Among 40 children failing first-line ART, treatment response was evaluated at weeks 24 and 48 after treatment was changed, based on GRT results.

Results: The mean age was 72 months both for children who were drug-naive and those failing ART (range: 3–144 and 12–144, respectively), with a mean viremia of 5.59 log and 4.71 log RNA copies/mL, a median CD4 of 17% (588 cells/μL) and 23% (719 cells/μL), respectively. Median time-to-treatment failure was 610 days. A prevalence of 4.9% and 90% drug resistance was observed, respectively, among children who were drug-naive and those failing first-line ART, with circulating recombinant form CRF02_AG as the most prevalent clade (58.6% and 62%, respectively). After a change to GRT-based treatment, more than 90% of children had viremia <3 log RNA copies/mL at week 24 and confirmed at week 48, with 70% achieving undetectable viremia, although without correlation to immune response; 97.5% had switched to lopinavir/ritonavir-containing regimens.

Conclusion: HIV-1 drug resistance was low among ART-naive children and very high among those failing first-line ART. Treatment change based on GRT was successful for most children, with lopinavir/ritonavir regimens being very promising for second-line use.

© 2011 Lippincott Williams & Wilkins, Inc.

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