Drug Resistance Profiles Among HIV-1–Infected Children Experiencing Delayed Switch and 12-Month Efficacy After Using Second-Line Antiretroviral Therapy: An Observational Cohort Study in Rural China

作者：Yan Zhao, Weiwei Mu, Joseph I. Harwell, Haiwei Zhou, Xin Sun, Yuewu Cheng, Chunming Li, Fujie Zhang · 发表于：JAIDS Journal of Acquired Immune Deficiency Syndromes · 年份：2011 · DOI：10.1097/qai.0b013e318229f2a2 · 被引用次数：27 · 研究领域：HIV/AIDS drug development and treatment、CRISPR and Genetic Engineering、HIV Research and Treatment

OBJECTIVE: To analyze the genotypic resistance profiles of HIV-infected children from rural China who were experiencing virologic failure to first-line antiretroviral therapy regimens and to evaluate 1-year regimen efficacy after switching to second-line therapy. METHODS: A prospective cohort study was performed. Seventy-six children from the first rural pilot program with HIV viral load >1000 copies per milliliter on 2 consecutive occasions were studied. We analyzed genotype results and observed second-line therapy efficacy to 12 months. RESULTS: After 33.1 (23.3, 41.1) months on first-line treatment after enrollment into national program, 98.7% of genotyped patients developed high-level resistance to nevirapine and 81.6% of patients had high-level resistance to efavirenz. High-level resistance to lamivudine was observed in 82.9%, followed by 57.9% for stavudine and 52.6% for zidovudine. In the nonnucleoside reverse transcriptase inhibitor class, the most common mutations were K103N/S at 50% and Y181C/I at 48.7%. M184V/I was the most common nucleoside reverse transcriptase inhibitor resistance mutation at 77.6%, the mutation rate for ≥3 thymidine analogue mutations, Q151M, and K65R were 33%, 12%, and 9%, respectively. After 12 months of boosted protease inhibitor-based second-line therapy, CD4 counts had on average increased 256 cells per cubic millimeter compared with switch baseline and 83.1% of patients had undetectable viral loads (<50 copies/mL). CONCLUSIONS: HIV-1-infe...