HIV ‐1 drug resistance prevalence, drug susceptibility and variant characterization in the J acobi M edical C enter paediatric cohort, B ronx, NY , USA

Objectives With the advent of combined antiretroviral therapy ( cART ), perinatally HIV ‐infected children are surviving into adolescence and beyond. However, drug resistance mutations ( DRMs ) compromise viral control, affecting the long‐term effectiveness of ART . The aims of this study were to detect and identify DRMs in a HIV‐1 infected paediatric cohort. Methods Paired plasma and dried blood spots ( DBSs ) specimens were obtained from HIV ‐1 perinatally infected patients attending the J acobi M edical C enter, N ew Y ork, USA . Clinical, virological and immunological data for these patients were analysed. HIV ‐1 pol sequences were generated from samples to identify DRMs according to the I nternational AIDS S ociety ( IAS ) 2011 list. Results Forty‐seven perinatally infected patients were selected, with a median age of 17.7 years, of whom 97.4% were carrying subtype B . They had a mean viral load of 3143 HIV ‐1 RNA copies/mL and a mean CD 4 count of 486 cells/μL at the time of sampling. Nineteen patients (40.4%) had achieved undetectable viraemia (< 50 copies/mL) and 40.5% had a CD 4 count of > 500 cells/μL. Most of the patients (97.9%) had received cART , including protease inhibitor ( PI )‐based regimens in 59.6% of cases. The DRM prevalence was 54.1, 27.6 and 27.0% for nucleoside reverse transcriptase inhibitors ( NRTIs ), PIs and nonnucleoside reverse transcriptase inhibitors ( NNRTIs ), respectively. Almost two‐thirds (64.9%) of the patients harboured DRMs to at least one drug class and 5.4% were triple resistant. The mean nucleotide similarity between plasma and DBS sequences was 97.9%. Identical DRM profiles were present in 60% of plasma− DBS paired sequences. A total of 30 DRMs were detected in plasma and 26 in DBSs , with 23 present in both. Conclusions Although more perinatally HIV ‐1‐infected children are reaching adulthood as a result of advances in cART , our study cohort presented a high prevalence of resistant viruses, especially viruses resistant to NRTIs . DBS specimens can be used for DRM detection.