Surveillance of pre-treatment drug resistanceamong HIV infected children in Ibadan, Nigeria Olusola Fiyinfoluwa I1,*, Oladokun Regina2, Falade Catherine1,3 1Department of Pharmacology and therapeutics, University of Ibadan, Ibadan.2Department of Paediatrics, College of Medicine, University of Ibadan & University College Hospital, Ibadan; 3Institute for Medical Research and training, University of Ibadan, Ibadan
There are about 2.1 million children infected with HIV globally out of which 120 thousand die annually. Nigeria has the highest rate of paediatric HIV infection globally. Despite this, there is limited information on the burden of HIV-1 drug resistance among children in the country. The emergence of drug resistant strains is a significant contributor to morbidity and mortality due to HIV infection. Pre-treatment HIV drug resistance data inform the choice of first- and second-line antiretroviral therapy (ART) regimens. This study therefore investigated the prevalence of HIV-1 drug resistant strains among ART naïve children in Ibadan, Nigeria. A total of 20 children aged less than 15 years were enrolled. Demographic, clinical and laboratory data were documented. Total nucleic acid was extracted from blood samples after which amplification of HIV-1 pol gene was done using polymerase chain reaction. Amplified gene was sequenced using big dye sequencing method. The sequenced HIV-1 pol genes were typed and analysed for identification of mutations indicative of drug resistance across the different classes of antiretroviral therapy using Rega subtyping tool Version 3 and Stanford HIV Drug Resistance Database. HIV 1 RNA pol gene was successfully amplified and identified in 12/20 (60%) children. These sequences were identified as HIV-1 subtypes G (n=4; 33%), CRF 02AG (n=4; 33%), Recombinant AG/G (1(8.3) and Recombinant AG/A1 (1(8.3). Two sequences (16.6%) were untypable. Drug resistant mutations were identified in four samples (33%), out of which three were NNRTI DRM (K103N) and the fourth a NRTI DRM (M184V). Results from this preliminary study suggest that HIV-1 drug resistance among ART-naïve children is a problem in Ibadan, Nigeria. Pre-treatment drug resistant testing is desirable in children prior to initiation of ART to guide effective treatment.
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