Prevalence of acquired resistance to antiretrovirals in children and adolescents living with HIV under clinical follow-up at the Roosevelt Hospital in Guatemala.

BACKGROUND

Insufficient HIV drug resistance (HIVDR) monitoring in Central America has resulted in widespread circulation of HIV-strains with drug resistance mutations (DRM), compromising antiretroviral therapy (ART). This study aimed to assess the first HIVDR data and DRM patterns in the only HIV-infected pediatric population with resistance information in Guatemala.

METHODS

All HIV-1 infected children and adolescents tested for HIVDR between 2013 and 2021 at Roosevelt Hospital (Guatemala) were retrospectively selected. Their first HIV-1 protease and/or partial retrotranscriptase sequence, when available, was recovered to detect acquired DRMs to three antiretroviral families, and predict resistance to 20 antiretrovirals using the Stanford HIVdb Algorithmv9.5. We compared results with previously recorded DRM data from clinical files. The HIV infecting variant was characterized by phylogeny in those with available sequence.

RESULTS

Ninety-nine children/adolescents were selected, most perinatally-infected (93 %) and without neonatal prophylaxis (92.3 %). The 66 with available sequences harbored HIV-1 subtype B. At first DRM genotyping, all had detectable viral loads (>40cp/ml), 58.6 % experienced virological failure (>1,000cp/ml) despite prior antiretroviral exposure (100 % to NRTI, 77.8 % to NNRTI, 32.3 % to PI and 4 % to INSTI). Most (77.9 %) experienced delayed HIV diagnostic. Half received ART within the first month post-diagnosis. Seventy-nine (79.8%) harbored viruses with DRM: 61 (61.6%) to NRTIs, 70 (70.7%) to NNRTIs and 6 (6.3%) to PIs (major DRMs). Half (52.5 %) presented dual resistance (NRTI+NNRTI) and 5.3 % triple (NRTI+NNRTI+PI). The most frequent DRM to NRTIs were M184V/I/M (47.5 %), to NNRTI K103N/R (48.5 %), and to PIs M46I/L/V (5.3 %). Most (88.4 %) carried PI-susceptible viruses.

CONCLUSION

This study updates HIVDR and HIV-1 variant data in Guatemala, offering the first resistance insights for HIV-infected children and adolescents, showing than PI and INSTI-based regimens may enhance HIV management in this vulnerable pediatric group. Periodic HIVDR monitoring is crucial to control the HIV epidemic in Guatemala.