Prevalence and risk factors associated with resistance-associated mutations to etravirine in a cohort of perinatally HIV-infected children
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Fecha
2013
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Publicado en
Journal of Antimicrobial Chemotherapy, 1460-2091, Vol. 68, No. 10, 2013 p. 2344-2348
Publicado por
Oxford University Press
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Resumen
Descripción
Abstract
Etravirine is a second-generation non-nucleoside reverse transcriptase inhibitor (NNRTI) with reduced cross-resistance to first-generation NNRTIs. Because many perinatally HIV-infected patients have been treated with first-generation NNRTIs, they may have acquired resistance-associated mutations to etravirine (RAMe).
We determined for the interval 1998–2009 the prevalence and factors associated with the presence of RAMe.
Twenty-three of 66 (34.8%) children had RAMe; the most common were 181C (19.6%), 190A (7.5%), 98G (6%), 106I (4.5%), 179D (4.5%), 100I (3%), 181I (1.5%), 138A (1.5%) and 179T (1.5%). Eleven children with RAMe (17%) had a mutation score between 2.5 and 3.5 and 1 (1.5%) a score ≥4, indicating an intermediate and reduced response to etravirine. For each 1% increase in CD4% there is a 7% decrease in the odds of RAMe (OR 0.93; 95% CI 0.88–0.97; P < 0.01). History of nevirapine use (OR 8.95; 95% CI 2.31–34.73; P < 0.01) and Hispanic ethnicity (OR 4.76; 95% CI 1.03–21.87; P = 0.04) are significantly associated with risk of RAMe.
RAMe are present and common among antiretroviral-experienced perinatally HIV-infected children without previous exposure to etravirine. This could limit the efficacy of etravirine-based regimens. In addition, our results underscore the importance of taking previous history of nevirapine into account for combined antiretroviral therapy regimens that contain etravirine.
Palabras clave
Keywords
Therapy adherence, Cumulative HIV RNA, Hispanics
Temáticas
Antivirales
VIH
Niño
VIH
Niño