HIV-1 drug resistance-associated mutations DRMs are key contributors to antiretroviral therapy ART failure.rnDespite most infants accessing early HIV-1 diagnosis in Kenya data remains limited on trends of DRMs among them. This studyrnaimed at investigating the trends of DRMs in newly HIV-diagnosed infants between 2014 and 2018
Dried blood spots DBS were collected from infants 18 months of age through the Kenya Early Infant Diagnosisrnprogram in 2014 2017 and 2018 n57 70 50 respectively. The DNA was extracted and HIV-1 reverse transcriptase genernwas amplified and sequenced for DRMs. Subtyping was done and DRMs checked following the IAS and Stanford HIVDBrnPROGRAM algorithm. Phylogenetics were done using the neighbor joining method.
DRMs conferring resistance to nucleoside reverse transcriptase inhibitors NRTI and non-NRTIs NNRTI werernrespectively found in 22.8 and 57.9 of infants in 2014 11.4 and 54.3 in 2017 14.0 and 58.0 in 2018. All infants whornhad NRTI-DRMs had NNRTI-DRMs. The frequency of DRMs did not differ in the three years however more NNRTI-DRMs thanrnNRTI-DRMs were found in all years P0.001. HIV subtype A was most common in all years 66.7 70.0 82.0 P0.44rnfollowed by subtype D. Y181C was most common in 2014 compared to 2017 and 2018 28.1 7.1 4.0 P0.0002 whereasrnK103N was more in 2017 and 2018 than in 2014 38.6 36.0 17.5 P0.026. The NNRTI-DRMs were associated withrnmother-to-child HIV transmission prevention PMTCT and infant prophylaxis history.
More than half of infants newly diagnosed with HIV harbored NNRTI resistance mutations. This was as a resultrnof possible maternal exposure to ART. Resistance mutation monitoring should be warranted for infants when ART is initiated.rnEffective PMTCT needs to be strengthened.