Tuesday, 5 August 2025

Alonso S, Salazar E, Gálvez N, Navas J, Quintana C, Orózco N, Prieto L, Navarro ML, Guillén S, Gómez JM, Medina C, Juarez J, Holguín A. Prevalence of acquired resistance to antiretrovirals in children and adolescents living with HIV under clinical follow-up at the Roosevelt Hospital in Guatemala.

J Infect Public Health. 2025

"The high number of treatment failures and cases of drug-resistant HIV in children and adolescents living with the virus could make it more difficult for Guatemala to reach the UNAIDS goals for controlling the HIV epidemic" - África Holguín

Summary:

Background: Insufficient HIV drug resistance (HIVDR) monitoring in Central America has resulted in widespread circulation of HIV-strains with drug resistance mutations (DRM), compromising antiretroviral therapy (ART). This study aimed to assess the first HIVDR data and DRM patterns in the only HIV-infected pediatric population with resistance information in Guatemala.

Methods: All HIV-1 infected children and adolescents tested for HIVDR between 2013 and 2021 at Roosevelt Hospital (Guatemala) were retrospectively selected. Their first HIV-1 protease and/or partial retrotranscriptase sequence, when available, was recovered to detect acquired DRMs to three antiretroviral families, and predict resistance to 20 antiretrovirals using the Stanford HIVdb Algorithmv9.5. We compared results with previously recorded DRM data from clinical files. The HIV infecting variant was characterized by phylogeny in those with available sequence.

Results: Ninety-nine children/adolescents were selected, most perinatally-infected (93 %) and without neonatal prophylaxis (92.3 %). The 66 with available sequences harbored HIV-1 subtype B. At first DRM genotyping, all had detectable viral loads (>40cp/ml), 58.6 % experienced virological failure (>1,000cp/ml) despite prior antiretroviral exposure (100 % to NRTI, 77.8 % to NNRTI, 32.3 % to PI and 4 % to INSTI). Most (77.9 %) experienced delayed HIV diagnostic. Half received ART within the first month post-diagnosis. Seventy-nine (79.8%) harbored viruses with DRM: 61 (61.6%) to NRTIs, 70 (70.7%) to NNRTIs and 6 (6.3%) to PIs (major DRMs). Half (52.5 %) presented dual resistance (NRTI+NNRTI) and 5.3 % triple (NRTI+NNRTI+PI). The most frequent DRM to NRTIs were M184V/I/M (47.5 %), to NNRTI K103N/R (48.5 %), and to PIs M46I/L/V (5.3 %). Most (88.4 %) carried PI-susceptible viruses.

Conclusion: This study updates HIVDR and HIV-1 variant data in Guatemala, offering the first resistance insights for HIV-infected children and adolescents, showing than PI and INSTI-based regimens may enhance HIV management in this vulnerable pediatric group. Periodic HIVDR monitoring is crucial to control the HIV epidemic in Guatemala.

Why do you highlight this publication?

This study highlights that periodic resistance monitoring is crucial for selecting optimal rescue therapies and for controlling the HIV epidemic in Guatemala, underscoring the urgent need to expand access to HIV drug resistance testing beyond its current limitation to Roosevelt Hospital. The findings also have significant implications for public health policy and clinical guidelines in the country, recommending the prioritization of specific antiretroviral drug families, due to their low prevalence of resistance. The data presented are already being considered in the ongoing updates of national HIV treatment guidelines and broader public health strategies.