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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*,††

The Pediatric Infectious Disease Journal: December 2011 - Volume 30 - Issue 12 - p 1062–1068
doi: 10.1097/INF.0b013e31822db54c
Pediatric HIV/AIDS

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.

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From the *Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon; †Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon; ‡Department of Experimental Medicine and Biochemical Sciences, University of Rome Tor Vergata, Rome, Italy; §Department of Biology, University of Rome Tor Vergata, Rome, Italy; ¶IRCSS Lazarro Spallanzani, Rome, Italy; ‖Faculty of Health Sciences, University of Buea, Buea, Cameroon; **Pediatric Unit, National Social Insurance Centre Hospital, Yaoundé, Cameroon; and ††National Research Council, Rome, Italy.

Accepted for publication July 14, 2011.

Supported by Italian National Institute of Health, Rome, through funding from the Italian Cooperation to the government of Cameroon, European Commission Framework 7 Programme (CHAIN, the Collaborative HIV and Anti-HIV Drug Resistance Network, Integrated Project N° 223131).

The authors have no other conflicts of interest to disclose.

Address for correspondence: Joseph Fokam, MSc, Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, PO Box 3077 Yaoundé-Messa, Yaoundé, Cameroon. E-mail: or

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© 2011 Lippincott Williams & Wilkins, Inc.