1. Background Results Methods Conclusion
Drug resistance mutations in newly-diagnosed HIV-1 infected Infants in Kenya
Kageha S1, Saina M2, Matilu MM1,4, Bi X2, Lihana R1, Mwangi J1, Ichimura H2 and Songok EM1,3
Kenya Medical Research Institute1, Kanazawa University2, University of Manitoba3, Consortium for National Health Research4
Background
Results
Mutations emerging in the viral proteins targeted by antiretroviral agents results in either susceptibility or development of resistance that compromise antiretroviral therapy (ART).
In Kenya, the number of children accessing early infant diagnosis program has increased tremendously over the years since inception 10 years ago. According to the NASCOP summary for the year 2014, an estimated 59,413 children were tested in the Early Infant Diagnosis program. Of these, 4,203 (7.1%) were positive, out of which, 2,115 (50.3%) were initiated on treatment while 373 (8.9%) were lost to follow up. About 250 (5.9%) HIV diagnosed children died in the same period.
However, HIV-1 viral resistance surveillance and monitoring among newly- diagnosed HIV infected infants has received little to no attention due to inhibitory costs of the assays.
HIV drug resistance (HIVDR) surveillance and monitoring systems to improve PMTCT and pediatric care and treatment choice is important.
The purpose of this study was to assess initial HIVDR mutations among children ≤ 18 months of age, newly diagnosed with HIV.
Objective
To determine the prevalence of HIV-1 drug resistance mutations (HIVDRMs) in infants born to HIV-1 positive mothers using remnant dried blood spots.
The prevalence of HIV-DRMs in infants who tested positive for HIV-1 was 17/30 (56.67%)
Of the 17/30, 17 had Non Nucleoside Reverse Transcriptase mutations (NNRTI) while 07 had Nucleoside Reverse Transcriptase inhibitions mutations (NRTI).
The most common NRTI was M184, I/V and K218 E/N/R whereas for NNRTI, Y181C was the most common, followed by K103N and G190A.
Most of the mutations occurred in multiples for both NRTI and NNRTI.
Protease sequences analyzed showed minor mutations such as L10V, K20M and L33F.
The dominant HIV-1 subtype was A, (n=8, 47.06%), CRF01_AE (n=4, 23.53%), D (n=2, 11.76%), C (n=2, 11.76%) and G (n=1, 5.88 %)
Summary of HIVDRMs
Methods
Conclusion
As scale-up to EID continues, it is evident that there is high prevalence of HIVDRMs among this population.
Prioritizing sentinel surveillance for the presence of HIV DRMs among this population is critical to inform treatment guidelines, prioritize regimens for optimal viral suppression besides maintaining durability in the long-term. .
Bibliography
Taha, T.E., Mother-to-child transmission of HIV-1 in sub-Saharan Africa: past, present and future challenges. Life Sci, (21-22): p
Bennett, D.E., et al., Recommendations for surveillance of transmitted HIV drug resistance in countries scaling up antiretroviral treatment. Antivir Ther, Suppl 2: p
Ziemniak, C., et al., Use of dried-blood-spot samples and in-house assays to identify antiretroviral drug resistance in HIV-infected children in resource-constrained settings Slower clearance of nevirapine resistant virus in infants failing extended nevirapine prophylaxis for prevention of mother-to-child HIV transmission. J Clin Microbiol, (12): p
Accessed on 07/18/2015