HIV Drug Resistance in Children and Adolescents: Always a Challenge?

Abstract

Purpose of Review With the expanded roll-out of antiretrovirals for treatment and prevention of HIV during the last decade, the emergence of HIV drug resistance (HIVDR) has become a growing challenge. This review provides an overview of the epidemiology and trajectory of HIVDR globally with an emphasis on pediatric and adolescent populations. Recent Findings HIVDR is associated with suboptimal virologic suppression and treatment failure, leading to an increased risk of HIV transmission to uninfected people and increased morbidity and mortality among people living with HIV. High rates of HIVDR to non-nucleoside reverse transcriptase inhibitors globally are expected to decline with the introduction of the integrase strand transfer inhibitors and long-acting combination regimens, while challenge remains for HIVDR to other classes of antiretroviral drugs. Summary We highlight several solutions including increased HIV viral load monitoring, expanded HIVDR surveillance, and adopting antiretroviral regimens with a high-resistance barrier to decrease HIVDR. Implementation studies and programmatic changes are needed to determine the best approach to prevent and combat the development of HIVDR.

Are we there yet? 40 years of successes and challenges for children and adolescents living with HIV

“…However, resistance testing as part of clinical care remains limited in LMIC, and its true burden is largely unknown [12]. The few available studies demonstrate extensive resistance to ART regimens commonly used in CAWH, whereas longitudinal outcomes data are limited to non‐existent [13,14]. Even as newer medications with high barriers to resistance are rolled out for CAWH (e.g.…”

Viral Response among Early Treated HIV Perinatally Infected Infants: Description of a Cohort in Southern Mozambique

“…Nationally, suboptimal viral suppression was partially due to the large proportion of children still on NVP or EFV based regimens, known to be associated with high primary resistance [ 39 ], while transition to the newly approved regimen containing LPV/r or Dolutegravir (DTG) started later. However, infants in our cohort were not on NVP based regimen but on LPV/r, and the results of the resistance test imply that the low suppression rate we found cannot be attributed to primary drug resistance to NVP nor to LPV/r [ 40 , 41 ].…”

“…However, results are consistent with data of other similar cohort in Sub Saharan Africa [ 23 , 24 ] and highlight important observational and clinically grounded findings which need further investigation, such as multidimensional correlates of adherence and VLS. The new DTG-based regimen, recently adopted by the country, is expected to improve adherence due the improved formulation, palatability, tolerability and once-daily administration [ 53 , 61 , 62 ], however VL response should be monitored to preserve this drug from emerging resistance [ 40 , 63 ]. Secondly, the results are generated in a study context which may be different from the ‘real life’ context and may overestimate results such as viral response and retention.…”

Editorial: New drugs for HIV: quo vadis?

“…For young patients, there are challenges with daily oral treatment regimens, including tolerability and palatability of ARVs, pill size, treatment fatigue, and, importantly for adolescents, HIV-related stigma. Virologic suppression rates are also lower in adolescents because of adherence challenges [9]. Longer acting antiretroviral therapy, as outlined in this edition, replacing daily oral therapy with less frequently dosed regimens, is a clear advance for these populations.…”