Children born with HIV are far more likely to develop resistance to antiretroviral drugs compared with adults, according to a poster presented at the Conference on Retroviruses and Opportunistic Infections in Boston, Mass.
“With extensive antiretroviral (ARV) exposure and the challenge of maintaining adherence, children and youth with perinatal HIV are at high risk for acquired drug resistance,” wrote Russell Van Dyke, MD, of Tulane University in New Orleans, and colleagues.
After studying 451 patients diagnosed with perinatal HIV aged 7 to 16 years from 2007 to 2009 enrolled in The Adolescent Master Protocol of the Pediatric HIV/AIDS Cohort Study, investigators abstracted genotypic resistance testing performed for clinical care. Results from those tests were compared with the overall results from the reference laboratory for 2006 and 2012.
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Of the 446 subjects with at least one viral load (VL) performed, 64% (n=284) had at least one VL ≥400 copies/mL and 230 had resistance testing results. Almost 75% had any ARV resistance; 61%, 40%, and 34%, respectively, had resistance to any nucleoside reverse transcriptase inhibitor (NRTI), any nucleoside/nucleotide reverse transcriptase inhibitor (NNRTI), or any protease inhibitor, substantially higher than that of the reference laboratory population.
The prevalence of resistance was highest for zidovudine, nevirapine, and efavirenz (40% each), and the prevalence of resistance was lowest for lopinavir (18%), etravirine (15%), and tipranavir (10%). Resistance to all ARVs in a class was uncommon, reported inspectors.
“Resistance is associated with more advanced disease prior to starting highly active antiretroviral therapy, a longer duration of HAART, and a greater number of HAART regimens,” wrote the researchers.
