High Drug Resistance Prevalence among Vertically HIV-Infected Patients Transferred from Pediatric Care to Adult Units in Spain
Identifieur interne : 003337 ( Main/Exploration ); précédent : 003336; suivant : 003338High Drug Resistance Prevalence among Vertically HIV-Infected Patients Transferred from Pediatric Care to Adult Units in Spain
Auteurs : Miguel De Mulder [Espagne] ; Gonzalo Yebra [Espagne] ; Adriana Navas [Espagne] ; María Isabel De José [Espagne] ; María Dolores Gurbindo [Espagne] ; María Isabel González-Tomé [Espagne] ; María José Mellado [Espagne] ; Jesús Saavedra-Lozano [Espagne] ; María Ngeles Mu Oz-Fernández [Espagne] ; Santiago Jiménez De Ory [Espagne] ; José Tomás Ramos [Espagne] ; África Holguín [Espagne]Source :
- PLoS ONE [ 1932-6203 ] ; 2012.
Abstract
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.
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.
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%
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.
Url:
DOI: 10.1371/journal.pone.0052155
PubMed: 23284913
PubMed Central: 3524105
Affiliations:
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Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Mellado, Maria Jose" sort="Mellado, Maria Jose" uniqKey="Mellado M" first="María José" last="Mellado">María José Mellado</name><affiliation wicri:level="3"><nlm:aff id="aff6"><addr-line>Pediatrics Department, Hospital Carlos III, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Pediatrics Department, Hospital Carlos III, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Saavedra Lozano, Jesus" sort="Saavedra Lozano, Jesus" uniqKey="Saavedra Lozano J" first="Jesús" last="Saavedra-Lozano">Jesús Saavedra-Lozano</name><affiliation wicri:level="3"><nlm:aff id="aff4"><addr-line>Pediatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Pediatrics Department, Hospital General Universitario Gregorio Marañón, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Mu Oz Fernandez, Maria Ngeles" sort="Mu Oz Fernandez, Maria Ngeles" uniqKey="Mu Oz Fernandez M" first="María Ngeles" last="Mu Oz-Fernández">María Ngeles Mu Oz-Fernández</name><affiliation wicri:level="3"><nlm:aff id="aff7"><addr-line>Molecular Immunobiology Laboratory, Hospital General Universitario Gregorio Marañón, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Molecular Immunobiology Laboratory, Hospital General Universitario Gregorio Marañón, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="De Ory, Santiago Jimenez" sort="De Ory, Santiago Jimenez" uniqKey="De Ory S" first="Santiago Jiménez" last="De Ory">Santiago Jiménez De Ory</name><affiliation wicri:level="3"><nlm:aff id="aff7"><addr-line>Molecular Immunobiology Laboratory, Hospital General Universitario Gregorio Marañón, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Molecular Immunobiology Laboratory, Hospital General Universitario Gregorio Marañón, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Ramos, Jose Tomas" sort="Ramos, Jose Tomas" uniqKey="Ramos J" first="José Tomás" last="Ramos">José Tomás Ramos</name><affiliation wicri:level="3"><nlm:aff id="aff8"><addr-line>Pediatrics Department, Hospital Universitario de Getafe, 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Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Yebra, Gonzalo" sort="Yebra, Gonzalo" uniqKey="Yebra G" first="Gonzalo" last="Yebra">Gonzalo Yebra</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Universitario Ramón y Cajal, IRYCIS and CIBER-ESP, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Universitario Ramón y Cajal, IRYCIS and CIBER-ESP, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Navas, Adriana" sort="Navas, Adriana" uniqKey="Navas A" first="Adriana" last="Navas">Adriana Navas</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Pediatrics Department, Hospital Universitario Infanta Leonor, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Pediatrics Department, Hospital Universitario Infanta Leonor, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="De Jose, Maria Isabel" sort="De Jose, Maria Isabel" uniqKey="De Jose M" first="María Isabel" last="De José">María Isabel De José</name><affiliation wicri:level="3"><nlm:aff id="aff3"><addr-line>Pediatrics Department, Hospital Universitario La Paz, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Pediatrics Department, Hospital Universitario La Paz, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Gurbindo, Maria Dolores" sort="Gurbindo, Maria Dolores" uniqKey="Gurbindo M" first="María Dolores" last="Gurbindo">María Dolores Gurbindo</name><affiliation wicri:level="3"><nlm:aff id="aff4"><addr-line>Pediatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Pediatrics Department, Hospital General Universitario Gregorio Marañón, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Gonzalez Tome, Maria Isabel" sort="Gonzalez Tome, Maria Isabel" uniqKey="Gonzalez Tome M" first="María Isabel" last="González-Tomé">María Isabel González-Tomé</name><affiliation wicri:level="3"><nlm:aff id="aff5"><addr-line>Pediatrics Department, Hospital Universitario Doce de Octubre, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Pediatrics Department, Hospital Universitario Doce de Octubre, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Mellado, Maria Jose" sort="Mellado, Maria Jose" uniqKey="Mellado M" first="María José" last="Mellado">María José Mellado</name><affiliation wicri:level="3"><nlm:aff id="aff6"><addr-line>Pediatrics Department, Hospital Carlos III, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Pediatrics Department, Hospital Carlos III, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Saavedra Lozano, Jesus" sort="Saavedra Lozano, Jesus" uniqKey="Saavedra Lozano J" first="Jesús" last="Saavedra-Lozano">Jesús Saavedra-Lozano</name><affiliation wicri:level="3"><nlm:aff id="aff4"><addr-line>Pediatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Pediatrics Department, Hospital General Universitario Gregorio Marañón, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Mu Oz Fernandez, Maria Ngeles" sort="Mu Oz Fernandez, Maria Ngeles" uniqKey="Mu Oz Fernandez M" first="María Ngeles" last="Mu Oz-Fernández">María Ngeles Mu Oz-Fernández</name><affiliation wicri:level="3"><nlm:aff id="aff7"><addr-line>Molecular Immunobiology Laboratory, Hospital General Universitario Gregorio Marañón, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Molecular Immunobiology Laboratory, Hospital General Universitario Gregorio Marañón, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="De Ory, Santiago Jimenez" sort="De Ory, Santiago Jimenez" uniqKey="De Ory S" first="Santiago Jiménez" last="De Ory">Santiago Jiménez De Ory</name><affiliation wicri:level="3"><nlm:aff id="aff7"><addr-line>Molecular Immunobiology Laboratory, Hospital General Universitario Gregorio Marañón, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Molecular Immunobiology Laboratory, Hospital General Universitario Gregorio Marañón, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Ramos, Jose Tomas" sort="Ramos, Jose Tomas" uniqKey="Ramos J" first="José Tomás" last="Ramos">José Tomás Ramos</name><affiliation wicri:level="3"><nlm:aff id="aff8"><addr-line>Pediatrics Department, Hospital Universitario de Getafe, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Pediatrics Department, Hospital Universitario de Getafe, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Holguin, Africa" sort="Holguin, Africa" uniqKey="Holguin A" first="África" last="Holguín">África Holguín</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Universitario Ramón y Cajal, IRYCIS and CIBER-ESP, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Universitario Ramón y Cajal, IRYCIS and CIBER-ESP, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>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.</p></sec><sec><title>Methods</title><p>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. <italic>Pol</italic> 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.</p></sec><sec><title>Results</title><p>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% <italic>vs</italic>. 8.4%). Triple resistance was similar to non-transferred pediatric patients (17.3% <italic>vs.</italic> 17.6%).</p></sec><sec><title>Conclusion</title><p>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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Welch, S" uniqKey="Welch S">S Welch</name></author><author><name sortKey="Sharland, M" uniqKey="Sharland M">M Sharland</name></author><author><name sortKey="Lyall, Eg" uniqKey="Lyall E">EG Lyall</name></author><author><name sortKey="Tudor Williams, G" uniqKey="Tudor Williams G">G Tudor-Williams</name></author><author><name sortKey="Niehues, T" uniqKey="Niehues T">T 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Méndez-Lagares</name></author><author><name sortKey="Ruiz Mateos, E" uniqKey="Ruiz Mateos E">E Ruiz-Mateos</name></author><author><name sortKey="De Mulder, M" uniqKey="De Mulder M">M de Mulder</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Holguin, A" uniqKey="Holguin A">A Holguín</name></author><author><name sortKey="Lospitao, E" uniqKey="Lospitao E">E Lospitao</name></author><author><name sortKey="L Pez, M" uniqKey="L Pez M">M López</name></author><author><name sortKey="De Arellano, Er" uniqKey="De Arellano E">ER de Arellano</name></author><author><name sortKey="Pena, Mj" uniqKey="Pena M">MJ Pena</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Karchava, M" uniqKey="Karchava M">M Karchava</name></author><author><name sortKey="Pulver, W" uniqKey="Pulver W">W Pulver</name></author><author><name sortKey="Smith, L" uniqKey="Smith L">L Smith</name></author><author><name sortKey="Philpott, S" uniqKey="Philpott S">S Philpott</name></author><author><name sortKey="Sullivan, Tj" uniqKey="Sullivan T">TJ Sullivan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Descamps, D" uniqKey="Descamps D">D Descamps</name></author><author><name sortKey="Chaix, Ml" uniqKey="Chaix M">ML Chaix</name></author><author><name sortKey="Montes, B" uniqKey="Montes B">B Montes</name></author><author><name sortKey="Pakianather, S" uniqKey="Pakianather S">S Pakianather</name></author><author><name sortKey="Charpentier, C" uniqKey="Charpentier C">C Charpentier</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Espagne</li></country><region><li>Communauté de Madrid</li></region><settlement><li>Madrid</li></settlement></list><tree><country name="Espagne"><region name="Communauté de Madrid"><name sortKey="De Mulder, Miguel" sort="De Mulder, Miguel" uniqKey="De Mulder M" first="Miguel" last="De Mulder">Miguel De Mulder</name></region><name sortKey="De Jose, Maria Isabel" sort="De Jose, Maria Isabel" uniqKey="De Jose M" first="María Isabel" last="De José">María Isabel De José</name><name sortKey="De Ory, Santiago Jimenez" sort="De Ory, Santiago Jimenez" uniqKey="De Ory S" first="Santiago Jiménez" last="De Ory">Santiago Jiménez De Ory</name><name sortKey="Gonzalez Tome, Maria Isabel" sort="Gonzalez Tome, Maria Isabel" uniqKey="Gonzalez Tome M" first="María Isabel" last="González-Tomé">María Isabel González-Tomé</name><name sortKey="Gurbindo, Maria Dolores" sort="Gurbindo, Maria Dolores" uniqKey="Gurbindo M" first="María Dolores" last="Gurbindo">María Dolores Gurbindo</name><name sortKey="Holguin, Africa" sort="Holguin, Africa" uniqKey="Holguin A" first="África" last="Holguín">África Holguín</name><name sortKey="Mellado, Maria Jose" sort="Mellado, Maria Jose" uniqKey="Mellado M" first="María José" last="Mellado">María José Mellado</name><name sortKey="Mu Oz Fernandez, Maria Ngeles" sort="Mu Oz Fernandez, Maria Ngeles" uniqKey="Mu Oz Fernandez M" first="María Ngeles" last="Mu Oz-Fernández">María Ngeles Mu Oz-Fernández</name><name sortKey="Navas, Adriana" sort="Navas, Adriana" uniqKey="Navas A" first="Adriana" last="Navas">Adriana Navas</name><name sortKey="Ramos, Jose Tomas" sort="Ramos, Jose Tomas" uniqKey="Ramos J" first="José Tomás" last="Ramos">José Tomás Ramos</name><name sortKey="Saavedra Lozano, Jesus" sort="Saavedra Lozano, Jesus" uniqKey="Saavedra Lozano J" first="Jesús" last="Saavedra-Lozano">Jesús Saavedra-Lozano</name><name sortKey="Yebra, Gonzalo" sort="Yebra, Gonzalo" uniqKey="Yebra G" first="Gonzalo" last="Yebra">Gonzalo Yebra</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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