In the USA and West Europe, nearly 80% of HIV-1-infected adults, experiencing virologic failure, harbored virus strain resistant to at least one antiretroviral drug. Limited data are available on antiretroviral drug resistance in pediatric HIV infection. The aims of this study were to analyze prevalence of HIV-1 drug resistance and to identify risk factors associated with resistance in this population. Prevalence of genotypic resistance was estimated retrospectively in treated children who experienced virologic failure (with HIV-1-RNA > 500 copies/ml) followed in Necker hospital between 2001 and 2003. Among 119 children with resistance testing, prevalence of resistance to any drug was 82.4%. Resistance ranged from 76.5% to nucleoside reverse transcriptase inhibitor (NRTI), to 48.7% to non-nucleoside reverse transcriptase inhibitor (NNRTI) and 42.9% to protease inhibitor (PI). Resistance to at least one drug of two classes and three classes (triple resistance) was 31.9 and 26.9%, respectively. Resistance was not associated with geographic origin, HIV-1 subtype, and CDC status. In multivariate analysis, resistance to any drug remained associated independently with current low viral load and high lifetime number of past PI. Triple resistance was independently associated with the high lifetime number of past PI and with gender, particularly among children aged 11 years old or more with a prevalence seven times higher in boys than in girls. In conclusion, antiretroviral resistance is common among treated HIV-1-infected children and prevalence was similar with those observed in adult population in the same year period. However, adolescent boys seem to be at greater risk.

译文

在美国和西欧,近80% 的HIV-1-infected成年人经历病毒学失败,携带对至少一种抗逆转录病毒药物有抗性的病毒株。关于小儿HIV感染中抗逆转录病毒药物耐药性的数据有限。这项研究的目的是分析HIV-1耐药性的患病率,并确定与该人群耐药性相关的危险因素。在Necker医院2001年和2003年随访的经历病毒学失败 (HIV-1-RNA> 500拷贝/ml) 的治疗儿童中,回顾性估计了基因型耐药性的患病率。在119名接受耐药性测试的儿童中,82.4% 了对任何药物的耐药性。抗药性范围从76.5% 到核苷类逆转录酶抑制剂 (NRTI),48.7% 到非核苷类逆转录酶抑制剂 (NNRTI) 和42.9% 到蛋白酶抑制剂 (PI)。分别31.9和26.9% 对至少一种两类和三类药物的抗性 (三重抗性)。抗药性与地理来源,HIV-1亚型和CDC状态无关。在多变量分析中,对任何药物的耐药性仍然与当前低病毒载量和过去PI的高寿命数独立相关。三重耐药性与过去PI的高寿命数和性别独立相关,尤其是在11岁或以上的儿童中,男孩的患病率是女孩的7倍。总之,抗逆转录病毒耐药性在接受治疗的HIV-1-infected儿童中很常见,患病率与同年成年人口中观察到的相似。然而,青春期男孩似乎面临更大的风险。

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