Журнал инфектологии (Jun 2017)
Cases inefficient antiretroviral therapy for HIV-1 in children
Abstract
Aim. Study cases virologic failure ART HIV-1 in children.Materials and methods. The blood plasma samples of 6 patients with HIV infection were used, identified under 1 year of life, from the North-West Federal District of the Russian Federation, received in 2014–2016. Presented in a group of patients were aimed at identifying drug resistance in the virus and correction of ART due to virological failure. In the present study we used genotyping by direct sequencing of the site of the polymerase gene (pol) length of 1285 nt., The gene encoding the protease (PR) length of 465 nt. and a portion of the reverse transcriptase (RT) gene length of 820 nt.Results. In all cases, I was diagnosed with HIV-1 subtype A1, the so-called IDU-A, which is the most common form of HIV-1 in the Russian Federation. Among the obtained isolates of HIV have been identified typical drug resistance mutations to NRTI and NNRTI. Detected multiple natural polymorphic variants from the land of the nucleotide sequences. Thus, all samples show protease mutation M36I, R41K, H69K, and L89M, five samples E35D, four samples I13V. Only one among the surveyed our children with combined variant protease gene mutations L63T + V77I + I93L and reverse transcriptase gene V35I + K166R, despite ongoing therapy and absence of significant drug resistance mutations, according to Stanford University-based data showed high viral load – 2.03×107 copies/ml. The importance of the influence of natural polymorphisms in the drug resistance of the virus is discussed.Conclusion. The high frequency of natural polymorphic variants of the protease and reverse transcriptase genes of the virus in clinical samples submitted. The number of such mutations, apparently does not depend on the number of treatment regimens, but found some correlation with adherence to treatment.
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