Important note: Information in this article was accurate in October 2002. The state of the art may have changed since the publication date.AIDSWEEKLY Plus; October 14, 2002
Michael Greer, Senior Medical Writer
"High levels of HIV-1 replication occur following perinatal infection and antiretroviral drugs may not fully suppress viral load during the early years of childhood," according to Jane Mullen and colleagues at King's College, Guy's and St. Thomas' Hospitals Trust, and St. George's Hospital in London. "Adherence to treatment may also be difficult among children."
These factors lead to a high rate of resistance mutations in children with HIV, especially among patients who do not respond to treatment, Mullen and coauthors said.
The researchers genotyped viral isolates from 26 children who failed to show virological suppression during antiretroviral therapy. All but two of these children were African, and 23 of the 24 African patients were infected with non-B HIV subtypes, they noted.
Roughly 90% of the children studied carried viral populations with resistance mutations in the reverse transcriptase gene, with protease resistance mutations seen in 33% of cases, according to the report. More than 90% of children carried viruses with resistant genotypes after unsuccessful lamivudine treatment, compared with 75% and 64% of those who failed to respond to nevirapine and zidovudine therapy respectively.
Adherence to treatment regimens fell below 90% in half of the study cohort (Antiretroviral drug resistance among HIV-1 infected children failing treatment. J Med Virol 2002 Nov;68(3):299-304).
"Antiretroviral drug resistance was common among this group of children failing therapy, the majority of whom were infected with non-B subtypes of HIV-1," Mullen and coauthors concluded. "As adherence to treatment was low in 50%, this was likely to be an important contributory factor."
Key points reported in this study include:
This article was prepared by AIDS Weekly editors from staff and other reports.
Reference
Mullen J, Leech S, O'Shea S, Chrystie IL, et al., "Antiretroviral drug resistance among HIV-1 infected children failing treatment", J Med Virol 2002 Nov;68(3):299-304
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