Protease inhibitor resistance in South African children with virologic failure
Date
2009
Authors
Van Zyl G.U.
Van Der Merwe L.
Claassen M.
Cotton M.F.
Rabie H.
Prozesky H.W.
Preiser W.
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background: In South Africa, first-line antiretroviral therapy for children younger than 3 years of age combines a protease inhibitor (PI) with 2 nucleoside reverse transcription inhibitors. In our study, some pediatric patients received ritonavir (RTV) as single PI (RTV-sPI) and others ritonavir-boosted lopinavir (LPV/r), which has a higher resistance barrier. We explored antiretroviral resistance mutations in pediatric patients failing PI-based antiretroviral therapy and the predictors of major PI resistance mutations (MPIRM) in these patients. MATERIALS AND Methods: We studied pediatric HIV patients at Tygerberg Academic Hospital experiencing virologic failure on a PI regimen. Mixed-effects linear-and mixed-effect logistic regression modeling, were used to explore predictors of MPIRM. Results: MPIRM were found in 12 of 17 patients exposed to RTV-sPI compared with 1 of 13 patients treated with LPV/r. Exposure to RTV-sPI was significantly associated with MPIRM, with both exposure time and estimated failing time on RTV-sPI being significant positive predictors of MPIRM. Neither CD4 count, viral load, age at first visit nor receiving rifampin predicted MPIRM. Conclusions: RTV-sPI in infants and children poses a significant risk of MPIRM which is dependent on the exposure time and time failing while receiving the regimen. © 2009 by Lippincott Williams & Wilkins.
Description
Keywords
lamivudine, lopinavir, rifampicin, ritonavir, thymidine derivative, article, CD4 lymphocyte count, child, clinical article, drug treatment failure, human, Human immunodeficiency virus, Human immunodeficiency virus infection, infant, preschool child, priority journal, risk assessment, risk factor, South Africa, Anti-Retroviral Agents, HIV, HIV Infections, Humans, Protease Inhibitors, Regression Analysis, Ritonavir, South Africa, Treatment Failure, Viral Load
Citation
Pediatric Infectious Disease Journal
28
12
28
12