Perfil genotípico do HIV-1 em crianças infectadas tratadas e não tratadas com antiretrovirais
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Data
2006-05-26
Autores
Yamaguti, Elizabete Pires
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Universidade Federal do Espírito Santo
Resumo
Although existing protocols to prevent HIV-1 vertical transmission have contributed to reduce infection within the pediatric population in developed countries, a significant large number of children is still been infected vertically in undeveloped countries. Data regarding the latter population is still scarce. The HIV genotypic profile of a cohort of HIV-1 infected children attending to the Infectious Disease/Pediatric AIDS Ward of the Children s Hospital Nossa Senhora da Glória - Vitória / ES was evaluated in the present work. Our data demonstrated that both the prevalence and the level of genotypic resistance mutations were more evident among patients receiving HAART therapy (Group B) when compared to treatment naive patients (Group A), which supports the previous data showing the key role of antiretroviral (ARV) drugs selective pressure on the emergence of resistant virus isolates. Antiretroviral primary resistance mutations were not found in the great majority of treatment naive children, supporting the hypothesis that vertical transmission occurred from mother that didn t know their serological status and were not under treatment with ARV, the highest prevalence of viral polymorphism non-related to ARV resistance was found in this group. The main goal of ARV therapy is to achieve total suppression of viral replication, in order to prevent the emergence of ARV resistant strain. Unfortunately, in 20-50% of patients initiating HAART this total suppression is not achieved, this failure rate may be even higher among patients in sequential treatment regimens. Although several factors could be associated with treatment failure, such as non-compliance, ARV pharmacokinetics and inadequate treatment regimens, the emergence of ARV resistant viral mutants is still the main responsible for treatment failure. The development of ARV resistance has a greater impact among pediatric patients due to the fact that it may lead to cross-resistance, which may limit the use of other ARV later on. Most of the children in Group B were under treatment with ARV for more than 7 years, including some that received AZT monotherapy, than double therapy and today are in their 2nd, 3rd or even 4th HAART regimen. This fact may explain the difficulty in achieving total suppression of viral replication and consequently the high frequency of treatment failure found among patients in this group. Data presented here emphasize the importance of the correct timing for beginning ARV therapy, as well as the correct choice of ARV to achieve viral replication suppression efficiently, without forgetting the importance of patient compliance to the therapeutic regimen enforced by the legal guardians of these children.
Descrição
Palavras-chave
Genotypic profile , Pediatric , Genotipagem
Citação
YAMAGUTI, Elizabete Pires. Perfil genotípico do HIV-1 em crianças infectadas tratadas e não tratadas com antiretrovirais. 2006. 144 f. Dissertação (Mestrado em Doenças Infecciosas) - Programa de Pós-Graduação em Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, 2006.