Factors Associated with Virological Failure and Genotypic Resistance Mutation Patterns in Children Receiving Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)-Based Antiretroviral Therapy in Kalasin Hospital

Abstract

Objectives : This study aimed to determine the rate and factors associated with virological failure  and describe genotypic resistance mutation patterns in children receiving  Non-nucleoside reverse trancriptase inhibitor antiretroviral therapy (NNRTI-based  ART) in HIV-infected children in Kalasin hospital.

Materials and Methods : A retrospective study was conducted from 1 October 2002 to 30 September 2012. The inclusion criteria were HIV-infected children who were 1-15 years old and receiving NNRTI-based ART and had not received any ART except for exposure to antiretroviral prophylaxis for mother-to-child transmission.Virologic failure (VF) was defined as plasma HIV-RNA  > 1000 copies/mL after 1 year of NNRTI-based ART.

Results : There were 86 HIV-infected children , 18 (20.93%) had VF. Risk factor associated with VF was poor adherence (OR 21.50, 95%CI : 6.33-72.98).  The rate of VF were increased from 4.69% to 14.48%, 21.27% and 28.86% in the 1^st to 3^rd, 5^th and 8^th  years after ART, respectively. Drug resistance to NRTIs and NNRTIs were 88.89% and 100% , respectively.The common NRTIs mutations were 184V (94.44%), D67N (50.00%) and TAMs≥4 (5.55%). The NNRTIs mutations were Y181C/I  (27.78%) , G190S/A  (50.00%)  and   K103N (16.67%).

Conclusions : The VF rate in children was high and increased by the years after ART. Factor associated with VF was poor adherence. The most common   resistance  mutations  were those conferring resistance to lamivudine (3TC) and NNRTIs. Closed monitoring of adherence would be useful for prevention of VF and early detection of VF might allow for early switching to second-line regimens.