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High Levels of HIV-1 Drug Resistance in Children Who Acquired HIV Infection Through Mother to Child Transmission in the Era of Option B+, Haiti, 2013 to 2014

Louis, Frantz Jean, MPH*; Segaren, Nathanael, MD, MPH, MSc; Desinor, Olbeg, MD, MPH; Beard, R. Suzanne, PhD§; Jean-Louis, Reginald, MD*; Chang, Joy, PhD§; Boisson, Sylvie, MD; Hulland, Erin N., MPH§; Wagar, Nick, BS§; DeVos, Joshua, MPH§; François, Kesner, MD; Buteau, Josiane, MD; Boncy, Jacques, MD; Marston, Barbara J., MD§; Domerçant, Jean Wysler, MD, MPH*; Yang, Chunfu, DVM, PhD§; Charles, Macarthur, MD, PhD*

The Pediatric Infectious Disease Journal: May 2019 - Volume 38 - Issue 5 - p 503–507
doi: 10.1097/INF.0000000000002270
HIV Reports

Background: The main objective of this study was to determine the frequency and patterns of HIV drug resistance–associated mutations among children under 18 months of age born to HIV-1–positive mothers enrolled in the prevention of mother-to-child transmission services in Haiti.

Methods: Between January 1, 2013 and December 31, 2014, HIV-positive remnant dried blood spots collected from children under 18 months of age for Early Infant Diagnosis at the National Public Health Laboratory were used for HIV-1 genotyping. HIV drug resistance mutations were analyzed using the Stanford Drug Resistance HIVdb program.

Results: Of the 3555 dried blood spots collected for Early Infant Diagnosis, 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 ≥1 drug resistance mutation. Mutations conferring resistance to nucleoside reverse transcriptase inhibitor (NRTIs) and non-NRTIs were present in 40.5% (123) and 69.1% (210), respectively. The most frequent mutations were K103N/S (48.0%), M184V (37.5%), 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 non-NRTIs and 11.5% had intermediate to high-level resistance to abacavir.

Conclusions: This study showed high rates of resistance to NRTIs and non-NRTIs 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 mother-to-child transmission of HIV 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.

From the *Centers for Disease Control and Prevention, Port-au-Prince, Haiti

CARIS Foundation, Port-au-Prince, Haiti

United States Agency for International Development, Port-au-Prince, Haiti

§Centers for Disease Control and Prevention, Atlanta, Georgia

Programme National de Lutte contre le VIH/SIDA, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti

Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti.

Accepted for publication December 9, 2018.

This manuscript was supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (GH15-152702) and the United States Agency for International Development (AID-521-A-14-00001).

The authors have no conflicts of interest to disclose.

The findings and conclusion of this manuscript are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention and the United States Agency for International Development.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address for correspondence: Macarthur Charles, Centers for Disease Control and Prevention, Blvd 15 Octobre, Tabarre 41, Port-au-Prince, Haiti. E-mail:

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