International Journal of STD & AIDS > Volume 20, Number 6 > Pp. 406-409

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Original research articles

Drug resistance in the Chinese National Pediatric Highly Active Antiretroviral Therapy Cohort: implications for paediatric treatment in the developing world

F Zhang MD ^* , J Haberer MD MS ^*  , H Wei MD PhD , N Wang ^*, A Chu ^*, Y Zhao MD ^* and H Zhao MD 

^* National Center for AIDS/STD Control and Prevention/Chinese Center for Disease Control and Prevention; Beijing Ditan Hospital, Beijing, China; Massachusetts General Hospital, Boston, MA 02138, USA

Correspondence to: Dr J Haberer, Harvard Initiative for Global Health, 104 Mt Auburn Street, 3rd Floor, Cambridge, MA 02138, USA Email: jhaberer{at}partners.org

China's National Pediatric ART Program began in 2005, in which 32 ART-experienced and 51 antiretroviral therapy (ART)-naïve children received paediatric formulations of (zidovudine or stavudine) plus lamivudine plus (nevirapine or efavirenz). Reverse transcriptase sequencing and analysis was performed on plasma samples with >1000 HIV copies/mL after one year of treatment. Thirty-four samples were sequenced. Nearly all patients had nucleoside reverse transcriptase inhibitor and non-nucleoside reverse transcriptase inhibitor mutations. High/intermediate resistance was found to lamivudine/emtricitabine in 31 patients; to didanosine, abacavir, stavudine and zidovudine in 18 patients; and to tenofovir in 11 patients. All had high-level resistance to nevirapine; all but one had high/intermediate-level resistance to efavirenz. Viral load was the only cohort characteristic significantly associated with developing resistance. Resistance to zidovudine, stavudine and tenofovir was more common in ART-experienced versus ART-naïve patients (P = 0.02–0.05). Drug resistance is high in this cohort. Second-line therapy will require additional ART strategies and options, which are currently unavailable in most developing settings.

Key Words: paediatric • drug resistance • highly active antiretroviral therapy

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