Resistance to Antiretroviral Drugs: A Threat to the Prevention and Treatment of Pediatric HIV Infection

Abstract

Mother-to-child transmission (MTCT) of HIV was recognized early in the worldwide AIDS pandemic and by the late 1980s abnormal psychomotor development candida esophagitis and recurrent invasive bacterial infections were recognized as signatures of HIV infection in infants. Pneumocystis pneumonia occurred in many infants within the first 3-6 months of life often preceding death by as little as 1 month. Although symptoms of HIV infection generally appeared much later children who developed symptoms in the first year of life generally died by 2-3 years of age and AIDS became the seventh leading cause of mortality in young children in the United States by 1996. Nucleoside analogue reverse-transcriptase inhibitor (NRTI) antiretroviral therapy delayed the progression of disease and zidovudine sometimes caused dramatic improvements in cognitive function but these salutary effects were usually modest and transient in nature. Fortunately striking progress in both the prevention and treatment of HIV infection of children was made in early to mid-1990s. Administration of zidovudine during pregnancy labor and delivery accompanied by 6 weeks of postnatal therapy for the infant was shown to reduce MTCT of HIV by 70%. A series of studies in the 1990s identified virological immunological and obstetrical variables linked with perinatal infection of infants. (excerpt)