Persistence of HIV drug resistance among South African children given nevirapine to prevent mother-to-child-transmission

OBJECTIVES : We set out to examine the prevalence and persistence of mutations conferring high-level non-nucleoside-reverse-transcriptase (NNRTI)-resistance in a cohort of HIV-infected children who had failed prophylaxis to prevent mother-to-child-transmission (PMTCT). DESIGN : A prospective observational cohort study at the Pediatric HIV Clinic at Kalafong Provincial Tertiary Hospital in Pretoria, South Africa. METHODS : Children referred for initiation of antiretroviral therapy (ART) were enrolled from July 2010 through February 2013. HIV drug resistance testing was performed using the oligonucleotide ligation assay (OLA) on dried blood spots (DBS) collected at enrolment and monthly follow-up visits for 2 years. RESULTS : South African children who failed HIV-prophylaxis had a high prevalence of NNRTI-resistant HIV (46/88; 52%). Among children with NNRTI-resistance, the frequency of the predominant resistant variant in each child's HIV-quasispecies was high (median 96%) at study entry (median age 7.5 months), and in 26 out of 27 followed a median of 13 months persisted at a high frequency (median 89%). CONCLUSION : Our finding that infants who fail HIV-prophylaxis frequently have long-lived NNRTI-resistant HIV suggests that resistance will likely persist through 36 months of age, when children qualify for NNRTI-based ART. These children may benefit from HIV drug resistance testing to guide selection of their treatment.A grant from the Delegation of the European Union to South Africa: Drug Resistance Surveillance and Treatment Monitoring Network for the Public Sector HIV Antiretroviral Treatment Programme in the Free State-Sante 2007/147-790, National Research Council of South Africa, Unlocking the Future, 61509; NIH R01 AI058723; Clinical Research and Retrovirology Core of the Seattle Centers for AIDS Research (NIH P30 AI027757), NIH T32 HD007233-32, Seattle Children’s Research Institute Strategic Funds; NIH funding of the International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT) Virology Developmental Laboratory award (U01 AI068632).http://journals.lww.com/aidsonline2018-05-15hj2017Family Medicin