Overview of genotypic and clinical profiles of human immunodeficiency virus type 1-infected children in Rio de Janeiro, Brazil

Elizabeth S Machado,Anne M Sill,Adriana O Afonso,Amilcar Tanuri,Silvia M Cunha,Marcelo A Soares,John S Lambert,Ricardo H Oliveira

doi:10.1590/s0001-37652004000400008

Abstract

Although mother-to-child HIV transmission prevention has slowed down pediatric HIV infection in developed countries, large numbers of infants still become infected in developing nations. Data on pediatric HIV infection is however largely scarce. In this study, we have overviewed clinical, laboratory and genotypic data from a large cohort of HIV-infected infants regularly followed at two pediatric HIV outpatient clinics in Rio de Janeiro, Brazil. Children on antiretroviral therapy, as well as drug-naive, newly diagnosed infants were analyzed. Prevalence of drug resistance mutations, as well as immunological and virological responses to therapy were evaluated. Additionally, HIV-1 subtype frequencies and their distribution over the course of the epidemic were studied. We have found a high prevalence of mutations among ARV-experienced children, whereas mutations were absent in the drug-naive group. Despite the high levels of resistance among treated infants, an important improvement of their immunological status was observed. HIV-1 subtype distribution followed the trends of the adult population, with the appearance of non-B subtypes and recombinant forms after 1990. To our knowledge, this is the largest pediatric cohort ever analyzed in Brazil, and the data provided is of paramount importance to a better understanding of HIV/AIDS evolution in pediatric settings.

Highlights

The use of potent antiretroviral (ARV) combination therapy as the standard of care for the treatment of HIV-1 has produced a remarkable change in the natural history of HIV disease
Overcoming the emergence of resistant strains during ARV therapy to obtain a durable suppression of virus replication is one of the main goals of combination therapy
Achieving this goal during clinical management is difficult and it is even more challenging when dealing with pediatric population

Summary

Introduction

The use of potent antiretroviral (ARV) combination therapy as the standard of care for the treatment of HIV-1 has produced a remarkable change in the natural history of HIV disease. Clinical improvement can be observed even in those with partial viral suppression, maximal suppression of viral replication continues to be the primary goal of therapy in order to prevent the emergence of resistant strains. Sustained virus suppression is not achieved in 20%-50% of the patients initiating highly active ARV therapy (HAART) and can be higher in subsequent treatments (Palella et al 2002, Phillips et al 2002, Mocroft et al 2003). Many factors are associated with detectable viremia, including poor adherence, drug pharmacokinetics, and suboptimal regimens, the emergence of drug-resistance strains is a leading cause of treatment failure in HIVinfected individuals

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Results

Conclusion