Salou Mounerou, Butel Christelle, Konou Abla A, Ekouevi Didier K, Vidal Nicole, Dossim Sika, Lawson-Evi Koko, Nyasenu Yawo T, Singo-Tokofaï Assetina, d'Almeida Senyedji, Tchama Raïssa, Delaporte Eric, Prince-David Mireille, Peeters Martine, Dagnra Anoumou Y
From the *Laboratoire de Biologie moléculaire et d'immunologie (BIOLIM/FSS/UL) and †Département des sciences fondamentales et biologiques, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo; ‡UMI 233, Institut de Recherche pour le Développement (IRD) and Université de Montpellier, Montpellier, France; §Département de Santé Publique, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo; ¶ISPED, Centre INSERM U897-Epidémiologie-Biostatistique and ‖Inserm U897, ISPED, Université de Bordeaux, Bordeaux, France; **Département de Pédiatrie, Faculté des Sciences de la Santé, Université de Lomé; and ††Programme National de Lutte contre le Sida et les IST/Togo (PNLS/IST/Togo), Lomé, Togo.
Pediatr Infect Dis J. 2016 Aug;35(8):879-85. doi: 10.1097/INF.0000000000001203.
Prevention of mother-to-child transmission (PMTCT) programs have been largely scaled-up, but data on infant HIV drug resistance from PMTCT programs implemented in resource-limited countries are lacking.
Remnant dried blood spots from HIV-infected children (aged <18 months) tested through the Togo national early infant diagnosis program during 2012 and 2013 were collected and assessed for HIV drug resistance. Pol-RT (reverse transcriptase) region was amplified, sequenced and analyzed for the presence of drug resistance mutations (DRMs).
Overall, 121 of 201 (60.2%) newly diagnosed children had detectable DRMs. Among the 131 of 201 (65.2%) children with reported exposure to maternal and/or infant antiretrovirals (ARVs), DRMs were detected in 99 children (75.6%). Importantly, in 41 of 201 children for whom no exposure to ARVs was reported, DRMs were detected in 11 children (26.8%). For 29 children, no data on ARV exposure were available. For the 121 of 201 children with DRMs, 99 of 121 (81.8%) had only nonnucleoside reverse transcriptase inhibitor DRMs detected but 21 of 121 (17.3%) had both nonnucleoside reverse transcriptase inhibitor and nucleoside reverse transcriptase inhibitor (NRTI) DRMs. Among breast-fed children, drug resistance was more frequent when mothers were on antiretroviral therapy (ART), 61 of 75 (81.3%) versus 14 of 39 (35.9%) when mothers were not on ART (P < 0.001). Nucleoside reverse transcriptase inhibitor resistance was more common when mothers were on ART.
Scale-up and improvement of PMTCT strategies resulted in a global decrease of pediatric HIV infections, but our study shows high rates of drug resistance in infants for whom prevention failed.
预防母婴传播（PMTCT）项目已大幅扩大规模，但在资源有限国家实施的PMTCT项目中，关于婴儿HIV耐药性的数据尚缺。
收集2012年至2013年期间通过多哥国家早期婴儿诊断项目检测的HIV感染儿童（年龄<18个月）残留的干血斑，并评估其HIV耐药性。对聚合酶逆转录酶（Pol-RT）区域进行扩增、测序，并分析耐药突变（DRMs）的存在情况。
总体而言，201名新诊断儿童中有121名（60.2%）检测到DRMs。在201名报告暴露于母亲和/或婴儿抗逆转录病毒药物（ARVs）的儿童中，有131名（65.2%），其中99名儿童（75.6%）检测到DRMs。重要的是，在201名报告未暴露于ARVs的儿童中，有41名，其中11名儿童（26.8%）检测到DRMs。有29名儿童没有ARV暴露的数据。在201名检测到DRMs的儿童中，121名中有99名（81.8%）仅检测到非核苷类逆转录酶抑制剂DRMs，但121名中有21名（17.3%）同时检测到非核苷类逆转录酶抑制剂和核苷类逆转录酶抑制剂（NRTI）DRMs。在母乳喂养的儿童中，母亲接受抗逆转录病毒治疗（ART）时耐药性更常见，母亲未接受ART时为39名中的14名（35.9%），而母亲接受ART时为75名中的61名（81.3%）（P<0.001）。母亲接受ART时，核苷类逆转录酶抑制剂耐药性更常见。
扩大和改进PMTCT策略导致全球儿童HIV感染率下降，但我们的研究表明，预防失败的婴儿中耐药率很高。
