Surveillance of antiretroviral drug resistance mutations in untreated young children living in the Central African Republic

Background: A survey of drug resistance-associated mutations (DRMs) was conducted in 2009 among 77 vertically HIV-infected children not treated by antiretroviral drugs, followed up at the Complexe Pediatrique of Bangui, (Bangui, Central African Republic), a country where HIV mother-to-child transmission is prevented by the wide use of single-dose nevirapine in delivering mother and neonate. Methods: Protease and reverse transcriptase sequencing was performed using the ViroSeq HIV-1 genotyping system, and DRMs were identified according to the 2009 update surveillance of transmitted HIV-1 drug resistance. Results: DRMs were detected in 6 out of 43 samples with interpretable genotypic resistance tests, leading to a 'moderate' DRM prevalence of 13.90/0 (95% CI 3.5-24.3). DRM to non-nucleoside reverse transcriptase inhibitors were found in 5 samples (11.6% [95% CI, 2.0-21.2]) involving K103N, Y181C and G190A mutations. DRMs to nucleoside reverse transcriptase inhibitors was found in 1 sample (2.3% [95% CI 0.0-6.8]), with the K219Q mutation. No DRMs to protease inhibitors was detected. Conclusions: This survey predicts a moderate (between 5% and 15%) prevalence of DRMs in the Central African HIV-infected paediatric population of Bangui. These observations highlight the need to make an early diagnosis of the possibility of virological failure in Central African children receiving their first-line antiretroviral regimen.