Abstract
Background: Most children access early human immunodeficiency virus type 1 (HIV-1) diagnosis in Kenya. However, the detection frequency of HIV-1 drug-resistance mutations (DRMs) among the children, main cause of their antiretroviral therapy (ART) failure, has not been well known. This study aimed at investigating the DRM trends in newly HIV-1-diagnosed Kenyan children between 2014 and 2018.
Methods: Dried blood spots (DBS) were collected from children with HIV-1 under 18 months of age through the Kenya Early Infant Diagnosis program in 2014, 2017 and 2018 (n = 57, 70, and 50, respectively). HIV-1 proviral DNA was extracted from the DBS and analyzed genetically. DRMs were checked following the IAS-USA list and/or Stanford HIV-1DB PROGRAM algorithm.
Results: Among the Kenyan children with HIV-1, DRMs were detected in 57.9% [nucleoside reverse transcriptase inhibitors (NRTI)-DRM/non-NRTI (NNRTI)-DRM: 22.8%/57.9%] in 2014, 54.3% (11.4%/54.3%) in 2017, and 58.0% (14.0%/58.0%) in 2018. All children who had NRTI-DRMs had NNRTI-DRMs. As for NNRTI-DRMs, Y181C was found more in 2014 than 2017/2018 (28.1% vs. 7.1%/6.0%, p = 0.0002), whereas K103N/S more in 2017/2018 than 2014 (37.1%/34.0% vs. 17.5%, p = 0.026). Among the children with DRMs, 94.9% and 67.7% showed high-level resistance to nevirapine and efavirenz (NNRTI), respectively. The mother’s PMTCT history was significantly associated with the NNRTI-DRMs in all years.
Conclusion: Majority of newly HIV-1-diagnosed Kenyan children continuously harbored DRMs between 2014 and 2018, which probably originated from their mothers’ PMTCT. Checking DRMs before starting ART and/or using non-NNRTI-containing regimen for ART should be considered in children with HIV-1 in Kenya.
