ABSTRACT
Background: Drug resistance mutations (DRMs) increasingly jeopardize paediatric HIV programmes in sub-Saharan Africa. As individual monitoring of DRMs and viral loads has limited availability, population data on DRMs are essential to determine first-line susceptibility. Paediatric data from sub-Saharan Africa are scarce and unavailable for Malawi. Objectives: To determine the prevalence of virological failure (VF) and DRMs among ART-naive HIV-infected Malawian children during the first year of first-line ART. Methods: In a prospective cohort of HIV-infected Malawian children, on first-line treatment, children were followed monthly; blood was collected for viral load testing (6 and 12 months) and genotypic resistance testing (12 months). VF was defined as at least one viral load >1000 copies/mL or death after 6 months of ART. DRMs were identified and susceptibility to NRTIs and NNRTIs was scored using the Stanford algorithm and by calculating genotypic susceptibility scores (GSSs). Results: VF occurred in 66% (23/35) of the children during 12 months of follow-up. DRMs were detected in 44% (15/34); all had NNRTI resistance and 12% (4/34) had dual-class NNRTI/NRTI resistance. Reduced susceptibility (DRMs and GSS <3) was seen in 41% (14/34) to their current first-line regimen. High-level resistance was most common for nevirapine [26% (9/34)]. Conclusions: In this first report on VF and DRMs in children on first-line ART in Malawi, the rates of VF and DRMs were alarmingly high. Paediatric HIV programmes in sub-Saharan Africa should emphasize programmatic evaluation of VF and include detection of DRMs to adjust and design adequate first- and second-line regimens and prevent widespread resistance in children.
Subject(s)
Anti-HIV Agents/therapeutic use , Drug Resistance, Viral , HIV Infections/drug therapy , HIV/drug effects , Mutation , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Genotype , Genotyping Techniques , HIV/genetics , HIV/isolation & purification , HIV Infections/epidemiology , HIV Infections/virology , Humans , Infant , Malawi/epidemiology , Male , Prevalence , Prospective Studies , Sequence Analysis, DNA , Treatment Failure , Viral LoadABSTRACT
Methanol extracts prepared separately from the roots, stems and leaves of four traditional Zulu medicinal plants (Rhoicissus digitata, R. rhomboidea, R. tomentosa and R. tridentata) were tested for their antioxidant activity. The extracts of R. rhomboidea and R. tridentata inhibited the activities of the 1, 1'-diphenyl-2-picryhydrazyl free radical, xanthine oxidase, and also prevented production of thiobarbituric acid reactive substances and free radical mediated DNA sugar damage. The extracts had a strong chelating effect on Fe(2+) ions. R. digitata and R. tomentosa extracts, however, possessed some prooxidative properties at high concentrations. In view of these results, it is apparent that the antioxidative activity of these Zulu medicinal plants plays an important role in the healing of the various diseases that they are used for.
