Pedro Kourí Tropical Medicine Institute, Havana, Cuba.
MEDICC Rev. 2011 Apr;13(2):24-31. doi: 10.37757/MR2011V13.N2.7.
INTRODUCTION The use of highly active antiretroviral therapy has reduced progression to AIDS and increased survival among seropositive persons; yet, appearance of resistant viruses may jeopardize these benefits. In Cuba, HIV mainly affects adults; at the end of 2009 of the 41 children infected, 25 were still alive; of these, 22 were under antiretroviral treatment. Until now, nothing was known about HIV-1 antiviral resistance and viral subtypes in the pediatric population in Cuba. OBJECTIVE This study aims to identify presence of antiretroviral-resistant HIV-1 strains in Cuban children and their mothers, and to provide a phylogenetic characterization and comparison of pol gene sequences in the same. METHODS Plasma samples were collected from 22 children and their mothers, all HIV-1-infected, from 2004 through 2009. Reverse transcription polymerase chain reaction was used to amplify the pol gene fragment coding for HIV protease and reverse transcriptase enzymes; this was then sequenced and subjected to phylogenetic analysis of HIV subtypes and recombinant forms to compare sequences between mothers and children. HIV mutations conferring antiretroviral resistance were determined. RESULTS Viral amplification was achieved in samples from 11 children and 8 mothers. Subtypes detected were: CRF19_cpx in five children, subtype B in three, CRF18_cpx in two, and subtype C in one child. In all mother-child pairs, samples were grouped within the same viral subtype in the phylogenetic tree. One mother was under treatment and five children had been treated before the sample was collected. In viruses amplified from samples of children under treatment, resistance was most frequently found to lamivudine (3 cases) and nevirapine (4 cases). Two untreated children carried resistant viruses possibly acquired from their mothers. CONCLUSIONS This is the first study to describe HIV-1 antiviral resistance in the pediatric population in Cuba; it also identified viral subtypes infecting the mother-child pairs studied. We recommend antiretroviral resistance assays before initiating treatment in pregnant seropositive women and their newborns.
引言 高效抗逆转录病毒疗法的使用降低了血清阳性者艾滋病的进展和死亡率，但耐药病毒的出现可能会危及这些益处。在古巴，HIV 主要影响成年人；截至 2009 年底，感染的 41 名儿童中，有 25 人仍然存活；其中 22 人接受了抗逆转录病毒治疗。到目前为止，古巴儿科人群中 HIV-1 抗病毒耐药性和病毒亚型还一无所知。 目的 本研究旨在确定古巴儿童及其母亲中是否存在抗逆转录病毒耐药的 HIV-1 株，并对同一基因的 pol 基因序列进行系统发育特征分析和比较。 方法 2004 年至 2009 年，采集了 22 名 HIV-1 感染的儿童及其母亲的血浆样本。采用逆转录聚合酶链反应扩增 HIV 蛋白酶和逆转录酶编码的 pol 基因片段；然后对其进行测序，并对 HIV 亚型和重组形式进行系统发育分析，比较母亲和儿童之间的序列。确定了赋予抗逆转录病毒耐药性的 HIV 突变。 结果 在 11 名儿童和 8 名母亲的样本中实现了病毒扩增。检测到的亚型有：5 名儿童为 CRF19_cpx，3 名儿童为亚型 B，2 名儿童为 CRF18_cpx，1 名儿童为亚型 C。在所有母婴对中，样本在系统发育树中均归属于同一病毒亚型。一名母亲正在接受治疗，五名儿童在采集样本前曾接受过治疗。在接受治疗的儿童样本中扩增的病毒中，最常见的是对拉米夫定（3 例）和奈韦拉平（4 例）耐药。两名未经治疗的儿童可能从母亲那里感染了耐药病毒。 结论 这是首次描述古巴儿科人群中 HIV-1 抗病毒耐药性的研究；它还确定了感染所研究母婴对的病毒亚型。我们建议在对血清阳性的孕妇及其新生儿开始治疗前进行抗逆转录病毒耐药性检测。
