Virological outcome among HIV infected patients transferred from pediatric care to adult units in Madrid, Spain (1997-2017)

Abstract

The aim of this transversal study was to describe the virological and immunological features of HIV-infected youths transferred from pediatric to adult care units since 1997 vs. the non-transferred patients from the Madrid Cohort of HIV-infected children and adolescents in Spain. We included 106 non-transferred and 184 transferred patients under clinical follow-up in 17 public hospitals in Madrid by the end of December 2017. Virological and immunological outcomes were compared in transferred vs. non-transferred patients. ART drug resistance mutations and HIV-variants were analyzed in all subjects with available resistance pol genotypes and/or genotypic resistance profiles. Among the study cohort, 133 (72.3%) of 184 transferred and 75 (70.7%) of 106 non-transferred patients had available resistance genotypes. Most (88.9%) of transferred had ART experience at sampling. A third (33.3%) had had a triple-class experience. Acquired drug resistance (ADR) prevalence was significantly higher in pretreated transferred than non-transferred patients (71.8% vs. 44%; p = 0.0009), mainly to NRTI (72.8% vs. 31.1%; p < 0.0001) and PI (29.1% vs. 12%; p = 0.0262). HIV-1 non-B variants were less frequent in transferred vs. non-transferred (6.9% vs. 32%; p < 0.0001). In conclusion, the frequent resistant genotypes found in transferred youths justifies the reinforcement of HIV resistance monitoring after the transition to avoid future therapeutic failures.

Figure 1

Acquired drug resistant prevalence and the most representative mutations in the study pretreated population from the Madrid Cohort of HIV-1 infected children and adolescents. (A) ADR prevalence according to drug class in 167 pretreated patients with pol sequence or resistance data. (B) ADR prevalence over 5% in 167 pretreated patients. Triple-class: ADR to NNRTI + NRTI + PI. ADR to NNRTI + PI was not found. Error bars indicate exact hybrid Wilson/Brown 95% CIs. Statistical differences: ****p < 0.0001; **p < 0.01; *p < 0.05 Chi-square test. Results were calculated in 49 PR and 45 RT sequences or resistance profiles from non-transferred patients and in 110 PR and 103 RT sequences or resistance profiles from transferred individuals at sampling. ADR acquired HIV drug resistance mutations, NTP non-transferred patients, TP transferred patients.

Figure 2

Predicted high resistance level to antiretroviral drugs in pretreated patients from the Madrid Cohort of HIV-1 infected children and adolescents. Susceptibility level was estimated in the 162 pretreated patients with available pol sequence according to the Stanford HIVdb Interpretation Algorithm. Error bars indicate exact hybrid Wilson/Brown 95% CIs. Statistical differences: **p < 0.01 Chi-square test. Results were calculated in 48 PR and 44 RT sequences from non-transferred patients and in 109 PR and 102 RT sequences from transferred individuals at sampling. ABC abacavir, AZT zidovudine, d4T stavudine, ddI didanosine, FTC emtricitabine, TDF tenofovir disoproxil fumarate, 3TC lamivudine, DOR doravirine, EFV efavirenz, ETR etravirine, NVP nevirapine, RPV rilpivirine, ATV atazanavir, DRV darunavir, FPV fosamprenavir, IDV indinavir, LPV lopinavir, NFV nelfinavir, SQV saquinavir, TPV tipranavir, NRTI nucleoside reverse-transcriptase inhibitor, NNRTI non-nucleoside reverse-transcriptase inhibitor, PI protease inhibitor.