Compromise of Second-Line Antiretroviral Therapy Due to High Rates of Human Immunodeficiency Virus Drug Resistance in Mozambican Treatment-Experienced Children With Virologic Failure
Journal of the Pediatric Infectious Diseases Society
; 9(1): 6-13, Feb 28. 2020. tab., graf
Artigo
em Inglês
| RDSM
| ID: biblio-1523711
Biblioteca responsável:
MZ1.1
ABSTRACT
Background:
Virologic failure (VF) is highly prevalent in sub-Saharan African children on antiretroviral therapy (ART) and is often associated with human immunodeficiency virus drug resistance (DR). Most children still lack access to routine viral load (VL) monitoring for early identification of treatment failure, with implications for the efficacy of second-line ART.Methods:
Children aged 1 to 14 years on ART for ≥12 months at 6 public facilities in Maputo, Mozambique were consecutively enrolled after informed consent. Chart review and caregiver interviews were conducted. VL testing was performed, and specimens with ≥1000 copies/mL were genotyped.Results:
Of the 715 children included, the mean age was 103 months, 85.8% had no immunosuppression, 73.1% were taking stavudine/lamivudine/nevirapine, and 20.1% had a history prevention of mother-to-child transmission exposure. The mean time on ART was 60.0 months. VF was present in 259 patients (36.3%); 248 (95.8%) specimens were genotyped, and DR mutations were found in 238 (96.0%). Severe immunosuppression and nutritional decline were associated with DR. M184V and Y181C were the most common mutations. In the 238 patients with DR, standard second-line ART would have 0, 1, 2, and 3 effective antiretrovirals in 1 (0.4%), 74 (31.1%), 150 (63.0%), and 13 (5.5%) patients, respectively.Conclusion:
This cohort had high rates of VF and DR with frequent compromise of second-line ART. There is urgent need to scale-up VL monitoring and heat-stable protease inhibitor formulations or integrase inhibitorsfor a more a durable first-line regimen that can feasibly be implemented in developing settings.
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Coleções:
Bases de dados nacionais
/
Moçambique
Contexto em Saúde:
Agenda de Saúde Sustentável para as Américas
/
ODS3 - Saúde e Bem-Estar
Problema de saúde:
Objetivo 5 Medicamentos, vacinas e tecnologias sanitárias
/
Meta 3.3: Acabar com as doenças tropicais negligenciadas e combater as doenças transmissíveis
Base de dados:
RDSM
Assunto principal:
Infecções por HIV
/
HIV
/
Estavudina
/
Lamivudina
/
Nevirapina
/
Farmacorresistência Viral
/
Antirretrovirais
Limite:
Adolescente
/
Criança
/
Criança, pré-escolar
/
Feminino
/
Humanos
/
Masculino
Idioma:
Inglês
Revista:
Journal of the Pediatric Infectious Diseases Society
Ano de publicação:
2020
Tipo de documento:
Artigo
Instituição/País de afiliação:
Centers for disease control and prevention/MZ
/
Division of global HIV and TB/MZ
/
Division of global HIV and TB/US
/
Fundação Ariel Glaser/MZ
/
Fundação ariel glaser/MZ
/
Instituto nacional de saude/MZ
/
University of California Los Angeles/US