HIV-1 pol gene sequences were analyzed from 77 HIV-1 positive children infected perinatally and exhibiting virological failure (VF). Viral subtyping, phylogenetic analysis, and genotypic drug resistance analysis were carried out on samples collected before start of anti retroviral treatment (ART) (baseline, BL), and at 12 months post-ART initiation (M12). Subtype C was found to be most predominant, seen in 75 of the 77 (97.4%) children. The level of pretreatment drug resistance (PDR) was 14% among these children. At BL, K103N (5), E138A/G (4), and M184V (3) were the most common mutations. At M12 the prevalence of any resistance-associated mutation (RAM) (acquired drug resistance/ADR) was 81.8% (63/77). Dual class resistance mutations were seen in 64% (49/77) of children. M184V/I, K103N/S, and Y181C were the most commonly occurring mutations, seen in 76%, 51%, and 36% children. RAMs to the second-generation non-nucleoside reverse transcriptase inhibitors (NNRTI), etravirine (ETR) and rilpivirine (RPV), were seen in 40.2% (31/77) and 48.05% (37/77) of the children, respectively. Our findings reveal similar prevalence rates of PDR and ADR in children with VF as reported in other studies. Occurrence of ETR and RPV resistance associated mutations (RAMs) is of concern and highlights the need for timely switch of regimens guided by genotypic resistance testing in perinatally infected children from India.

中文翻译：

---

病毒学失败儿童垂直传播 HIV-1 菌株 pol 基因的分子特征

HIV-1波尔分析了 77 名围产期感染并表现出病毒学失败 (VF) 的 HIV-1 阳性儿童的基因序列。对开始抗逆转录病毒治疗 (ART)（基线，BL）和 ART 开始后 12 个月（M12）收集的样本进行病毒亚型分析、系统发育分析和基因型耐药性分析。发现 C 亚型占主导地位，见于 77 名儿童中的 75 名 (97.4%)。这些儿童的治疗前耐药性（PDR）水平为14%。在 BL，K103N (5)、E138A/G (4) 和 M184V (3) 是最常见的突变。在 M12 时，任何耐药相关突变 (RAM)（获得性耐药性/ADR）的发生率为 81.8% (63/77)。64% (49/77) 的儿童出现双重耐药突变。M184V/I、K103N/S 和 Y181C 是最常见的突变，见于 76%，51% 和 36% 的儿童。第二代非核苷类逆转录酶抑制剂 (NNRTI)、依曲韦林 (ETR) 和利匹韦林 (RPV) 的 RAM 分别见于 40.2% (31/77) 和 48.05% (37/77) 的儿童。我们的研究结果显示，与其他研究报告的 VF 儿童中 PDR 和 ADR 的患病率相似。ETR 和 RPV 耐药相关突变 (RAM) 的发生令人担忧，并强调了在印度围产期感染儿童的基因型耐药检测指导下及时转换治疗方案的必要性。我们的研究结果显示，与其他研究报告的 VF 儿童中 PDR 和 ADR 的患病率相似。ETR 和 RPV 耐药相关突变 (RAM) 的发生令人担忧，并强调了在印度围产期感染儿童的基因型耐药检测指导下及时转换治疗方案的必要性。我们的研究结果显示，与其他研究报告的 VF 儿童中 PDR 和 ADR 的患病率相似。ETR 和 RPV 耐药相关突变 (RAM) 的发生令人担忧，并强调了在印度围产期感染儿童的基因型耐药检测指导下及时转换治疗方案的必要性。