HIV Drug Resistance among Children Initiating First-Line Antiretroviral Treatment (ART) in Uganda

BACKGROUND:

There is limited data on primary HIV drug resistance (HIVDR) in pediatric populations. This study aimed to assess the prevalence of primary HIVDR and associated risk factors among children initiating first-line ART in Uganda.

METHODS:

At three Ugandan clinics children (age<12 years) requiring anti-retroviral therapy (ART) were recruited between January 2010-August 2011. Prior to ART start blood was collected for viral load and pol gene sequencing. Drug resistance mutations were determined using the 2010 IAS-USA mutation list. Risk factors for HIVDR were assessed with multivariate regression analysis.

RESULTS:

319 HIV-infected children with a median age 4.9 years were enrolled. Sequencing was successful for 279 (87.5%). HIVDR was present in 10% of all children and 15.2% of children <3 years. Nucleoside reverse transcriptase inhibitors (NRTI), non-NRTI (NNRTI) and dual-class resistance was present in 5.7%, 7.5% and 3.2% respectively. HIVDR occurred in 35.7% of PMTCT-exposed children, 15.6% in children with unknown PMTCT history and 7.7.% among ARV-naive children. History of PMTCT-exposure (AOR:2.6, 95%-CI:1.3-5.1) or unknown PMTCT status (AOR:3.8, 95%-CI:1.1-13.5), low CD4 (AOR:2.2, 95%-CI:1.3-3.6), current breastfeeding (AOR:7.4, 95%-CI:2.6-21) and current maternal ART use (AOR:6.4, 95%-CI: 3.4-11.9), emerged as risk factors for primary HIVDR in multivariate analysis.

CONCLUSION:

Pretreatment HIVDR is high, especially in children with PMTCT exposure. PI-based regimens are advocated by WHO, but availability in children is limited. Children with (unknown) PMTCT exposure, low CD4 count, current breastfeeding or maternal ART need to be prioritized to receive PI based regimens.

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By:   Kityo C1, Sigaloff KC2, Boender ST3, Kaudha E4, Kayiwa J5, Musiime V6, Mukuye A7, Kiconco M8, Nankya I9, Nakatudde L10, Calis JC11, Rinke de Wit TF12,Mugyenyi P13.

• 1Joint Clinical Research Centre, Kampala, Uganda, Kampala, Uganda ; ckityo@yahoo.com.
• 2Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands, Amsterdam, Netherlands ; k.sigaloff@pharmaccess.org.
• 3Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands, Amsterdam, Netherlands ; s.boender@aighd.org.
• 4Joint Clinical Research Centre, Kampala, Uganda, Kampala, Uganda ; ekaudha@jcrc.org.ug.
• 5Joint Clinical Research Centre, Kampala, Uganda, Kampala, Uganda ; joshua.kayiwa@gmail.com.
• 6Joint Clinical Research Centre, Kampala, Uganda, Kampala, Uganda ; vmusiime@jcrc.org.ug.
• 7Joint Clinical Research Centre, Kampala, Uganda, Kampala, Uganda ; mukdre@yahoo.com.
• 8Joint Clinical Research Centre, Kampala, Uganda, Kampala, Uganda ; mkiconco@jcrc.org.ug.
• 9Joint Clinical Research Centre, Kampala, Uganda, Kampala, Uganda ; inankya@hotmail.com.
• 10Joint Clinical Research Centre, Kampala, Uganda, Kampala, Uganda ; lnakatudde@yahoo.com.
• 11Emma Children's Hospital, Academic Medical Centre, Amsterdam, Netherlands, Amsterdam, Netherlands ; job.calis@gmail.com.
• 12Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands, Amsterdam, Netherlands ; t.rinkedewit@pharmaccess.org.
• 13Joint Clinical Research Centre, Kampala, Uganda, Kampala, Uganda ; pmugyenyi@jcrc.org.ug.
• AIDS Res Hum Retroviruses. 2016 Jan 1. 

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