High drug resistance prevalence among vertically HIV-infected patients transferred from pediatric care to adult units in Spain.

<h4>Background</h4>Antiretroviral treatment (ART) has contributed to increased life expectancy of HIV-1 infected children. In developed countries, an increasing number of children reaching adulthood are transferred to adult units. The objectives were to describe the demographic and clini...

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Autores principales:	Miguel de Mulder, Gonzalo Yebra, Adriana Navas, María Isabel de José, María Dolores Gurbindo, María Isabel González-Tomé, María José Mellado, Jesús Saavedra-Lozano, María Ángeles Muñoz-Fernández, Santiago Jiménez de Ory, José Tomás Ramos, Africa Holguín, Madrid Cohort of HIV-Infected Children
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f5bb0d8e6b9b4a2ea8f04fd82a3aed53
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spelling	oai:doaj.org-article:f5bb0d8e6b9b4a2ea8f04fd82a3aed532021-11-18T08:04:46ZHigh drug resistance prevalence among vertically HIV-infected patients transferred from pediatric care to adult units in Spain.1932-620310.1371/journal.pone.0052155https://doaj.org/article/f5bb0d8e6b9b4a2ea8f04fd82a3aed532012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23284913/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Antiretroviral treatment (ART) has contributed to increased life expectancy of HIV-1 infected children. In developed countries, an increasing number of children reaching adulthood are transferred to adult units. The objectives were to describe the demographic and clinical features, ART history, antiviral drug resistance and drug susceptibility in HIV-1 perinatally infected adolescents transferred to adult care units in Spain from the Madrid Cohort of HIV-1 infected children.<h4>Methods</h4>Clinical, virological and immunological features of HIV-1 vertically infected patients in the Madrid Cohort of HIV-infected children were analyzed at the time of transfer. Pol sequences from each patient were recovered before transfer. Resistance mutations according to the InternationaI AIDS Society 2011 list were identified and interpreted using the Stanford algorithm. Results were compared to the non-transferred HIV-1 infected pediatric cohort from Madrid.<h4>Results</h4>One hundred twelve infected patients were transferred to adult units between 1997 and 2011. They were mainly perinatally infected (93.7%), with a mean nadir CD4+-T-cells count of 10% and presented moderate or severe clinical symptoms (75%). By the time of transfer, the mean age was 18.9 years, the mean CD4+T-cells count was 627.5 cells/ml, 64.2% presented more than 350 CD4+T-cells/ml and 47.3% had ≤ 200 RNA-copies/ml. Most (97.3%) were ART experienced receiving Highly Active ART (HAART) (84.8%). Resistance prevalence among pretreated was 50.9%, 76.9% and 36.5% for Protease Inhibitors (PI), Nucleoside Reverse Transcriptase Inhibitors (NRTI) and Non-NRTI (NNRTI), respectively. Resistance mutations were significantly higher among transferred patients compared to non-transferred for the PI+NRTI combination (19% vs. 8.4%). Triple resistance was similar to non-transferred pediatric patients (17.3% vs. 17.6%).<h4>Conclusion</h4>Despite a good immunological and virological control before transfer, we found high levels of resistance to PI, NRTI and triple drug resistance in HIV-1 infected adolescents transferred to adult units.Miguel de MulderGonzalo YebraAdriana NavasMaría Isabel de JoséMaría Dolores GurbindoMaría Isabel González-ToméMaría José MelladoJesús Saavedra-LozanoMaría Ángeles Muñoz-FernándezSantiago Jiménez de OryJosé Tomás RamosAfrica HolguínMadrid Cohort of HIV-Infected ChildrenPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 12, p e52155 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Miguel de Mulder Gonzalo Yebra Adriana Navas María Isabel de José María Dolores Gurbindo María Isabel González-Tomé María José Mellado Jesús Saavedra-Lozano María Ángeles Muñoz-Fernández Santiago Jiménez de Ory José Tomás Ramos Africa Holguín Madrid Cohort of HIV-Infected Children High drug resistance prevalence among vertically HIV-infected patients transferred from pediatric care to adult units in Spain.
description	<h4>Background</h4>Antiretroviral treatment (ART) has contributed to increased life expectancy of HIV-1 infected children. In developed countries, an increasing number of children reaching adulthood are transferred to adult units. The objectives were to describe the demographic and clinical features, ART history, antiviral drug resistance and drug susceptibility in HIV-1 perinatally infected adolescents transferred to adult care units in Spain from the Madrid Cohort of HIV-1 infected children.<h4>Methods</h4>Clinical, virological and immunological features of HIV-1 vertically infected patients in the Madrid Cohort of HIV-infected children were analyzed at the time of transfer. Pol sequences from each patient were recovered before transfer. Resistance mutations according to the InternationaI AIDS Society 2011 list were identified and interpreted using the Stanford algorithm. Results were compared to the non-transferred HIV-1 infected pediatric cohort from Madrid.<h4>Results</h4>One hundred twelve infected patients were transferred to adult units between 1997 and 2011. They were mainly perinatally infected (93.7%), with a mean nadir CD4+-T-cells count of 10% and presented moderate or severe clinical symptoms (75%). By the time of transfer, the mean age was 18.9 years, the mean CD4+T-cells count was 627.5 cells/ml, 64.2% presented more than 350 CD4+T-cells/ml and 47.3% had ≤ 200 RNA-copies/ml. Most (97.3%) were ART experienced receiving Highly Active ART (HAART) (84.8%). Resistance prevalence among pretreated was 50.9%, 76.9% and 36.5% for Protease Inhibitors (PI), Nucleoside Reverse Transcriptase Inhibitors (NRTI) and Non-NRTI (NNRTI), respectively. Resistance mutations were significantly higher among transferred patients compared to non-transferred for the PI+NRTI combination (19% vs. 8.4%). Triple resistance was similar to non-transferred pediatric patients (17.3% vs. 17.6%).<h4>Conclusion</h4>Despite a good immunological and virological control before transfer, we found high levels of resistance to PI, NRTI and triple drug resistance in HIV-1 infected adolescents transferred to adult units.
format	article
author	Miguel de Mulder Gonzalo Yebra Adriana Navas María Isabel de José María Dolores Gurbindo María Isabel González-Tomé María José Mellado Jesús Saavedra-Lozano María Ángeles Muñoz-Fernández Santiago Jiménez de Ory José Tomás Ramos Africa Holguín Madrid Cohort of HIV-Infected Children
author_facet	Miguel de Mulder Gonzalo Yebra Adriana Navas María Isabel de José María Dolores Gurbindo María Isabel González-Tomé María José Mellado Jesús Saavedra-Lozano María Ángeles Muñoz-Fernández Santiago Jiménez de Ory José Tomás Ramos Africa Holguín Madrid Cohort of HIV-Infected Children
author_sort	Miguel de Mulder
title	High drug resistance prevalence among vertically HIV-infected patients transferred from pediatric care to adult units in Spain.
title_short	High drug resistance prevalence among vertically HIV-infected patients transferred from pediatric care to adult units in Spain.
title_full	High drug resistance prevalence among vertically HIV-infected patients transferred from pediatric care to adult units in Spain.
title_fullStr	High drug resistance prevalence among vertically HIV-infected patients transferred from pediatric care to adult units in Spain.
title_full_unstemmed	High drug resistance prevalence among vertically HIV-infected patients transferred from pediatric care to adult units in Spain.
title_sort	high drug resistance prevalence among vertically hiv-infected patients transferred from pediatric care to adult units in spain.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/f5bb0d8e6b9b4a2ea8f04fd82a3aed53
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High drug resistance prevalence among vertically HIV-infected patients transferred from pediatric care to adult units in Spain.

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