Inzaule Seth C, Osi Samuels J, Akinbiyi Gbenga, Emeka Asadu, Khamofu Hadiza, Mpazanje Rex, Ilesanmi Oluwafunke, Ndembi Nicaise, Odafe Solomon, Sigaloff Kim C E, Rinke de Wit Tobias F, Akanmu Sulaimon
Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands.
APIN Public Health Initiative in Nigeria, Abuja, Nigeria.
J Acquir Immune Defic Syndr. 2018 Jan 1;77(1):e1-e7. doi: 10.1097/QAI.0000000000001553.
WHO recommends protease-inhibitor-based first-line regimen in infants because of risk of drug resistance from failed prophylaxis used in prevention of mother-to-child transmission (PMTCT). However, cost and logistics impede implementation in sub-Saharan Africa, and >75% of children still receive nonnucleoside reverse transcriptase inhibitor-based regimen (NNRTI) used in PMTCT.
We assessed the national pretreatment drug resistance prevalence of HIV-infected children aged <18 months in Nigeria, using WHO-recommended HIV drug resistance surveillance protocol. We used remnant dried blood spots collected between June 2014 and July 2015 from 15 early infant diagnosis facilities spread across all the 6 geopolitical regions of Nigeria. Sampling was through a probability proportional-to-size approach. HIV drug resistance was determined by population-based sequencing.
Overall, in 48% of infants (205 of 430) drug resistance mutations (DRM) were detected, conferring resistance to predominantly NNRTIs (45%). NRTI and multiclass NRTI/NNRTI resistance were present at 22% and 20%, respectively, while resistance to protease inhibitors was at 2%. Among 204 infants with exposure to drugs for PMTCT, 57% had DRMs, conferring NNRTI resistance in 54% and multiclass NRTI/NNRTI resistance in 29%. DRMs were also detected in 34% of 132 PMTCT unexposed infants.
A high frequency of PDR, mainly NNRTI-associated, was observed in a nationwide surveillance among newly diagnosed HIV-infected children in Nigeria. PDR prevalence was equally high in PMTCT-unexposed infants. Our results support the use of protease inhibitor-based first-line regimens in HIV-infected young children regardless of PMTCT history and underscore the need to accelerate implementation of the newly disseminated guideline in Nigeria.
由于预防母婴传播（PMTCT）中使用的预防措施失败会产生耐药风险，世界卫生组织建议在婴儿中采用基于蛋白酶抑制剂的一线治疗方案。然而，成本和后勤问题阻碍了该方案在撒哈拉以南非洲地区的实施，超过75%的儿童仍接受PMTCT中使用的基于非核苷类逆转录酶抑制剂的治疗方案（NNRTI）。
我们采用世界卫生组织推荐的HIV耐药监测方案，评估了尼日利亚18个月以下HIV感染儿童的国家治疗前耐药流行情况。我们使用了2014年6月至2015年7月期间从尼日利亚6个地缘政治区域的15个早期婴儿诊断机构收集的残余干血斑。抽样采用概率比例规模抽样法。HIV耐药性通过基于人群的测序确定。
总体而言，在48%的婴儿（430例中的205例）中检测到耐药突变（DRM），主要对NNRTIs耐药（45%）。核苷类逆转录酶抑制剂（NRTI）和多类NRTI/NNRTI耐药分别占22%和20%，而对蛋白酶抑制剂的耐药率为2%。在204例接受过PMTCT药物治疗的婴儿中，57%有DRM，其中54%对NNRTIs耐药，29%对多类NRTI/NNRTIs耐药。在132例未接受PMTCT的婴儿中，34%也检测到了DRM。
在尼日利亚对新诊断的HIV感染儿童进行的全国性监测中，观察到较高频率的原发性耐药，主要与NNRTIs相关。在未接受PMTCT的婴儿中，原发性耐药流行率同样很高。我们的结果支持在HIV感染的幼儿中使用基于蛋白酶抑制剂的一线治疗方案，无论其PMTCT病史如何，并强调在尼日利亚加速实施新发布指南的必要性。
