Prevalence of HIV-1 drug resistance among early diagnosed HIV-infected children enrolled through the national program for prevention of mother-to-child transmission in Southern and Central Highland provinces — Vietnam within 2017–2021

Background. In Vietnam, there has been an increase in efforts to monitor and prevent mother-to-child transmission of HIV since 2013. However, data on HIV drug resistance among HIV-1 infected children younger than 18 months of age remain limited. The study fills a critical knowledge gap by providing important insights into the prevalence of resistance among this population in the Southern and Central Highland provinces of Vietnam. Objective. This study aimed to determine the prevalence of HIV drug resistance and patterns of mutation among treatment-naïve children under the age of 18 months who had been recently diagnosed with HIV. Material and methods. Between May 2017 and May 2021, stored remnant DBS samples were collected from children under the age of 18 months who had been diagnosed with HIV through routine Early Infant Diagnosis testing in Central Highland and Southern Vietnam. HIV drug resistance tests were performed, and interpretation was done using the Stanford algorithm. Results and discussion. Overall, 111 samples with eligible viremia for sequencing (ct value <31) were collected for genotyping, in which 110 protease sequences and 106 complete reverse transcriptase regions were generated. Males were 61.3%, 52.3% were aged from 6 weeks to <9 months and 37.0% were breastfed. Access to mother-to-child intervention was reported in 60.3%. The accumulation of major drug resistance mutations was found in 43.8% of infants and most of them were resistant to Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI) (37.7%). High-level resistance to Nevirapine was present in 40% of cases. The risk factors associated with NNRTI resistance were antiretroviral prophylaxis (aOR: 3.68, 95% CI: 1.83–7.45) and breast-feeding history (aOR: 2.16, 95% CI: 1.03–4.53). CRF01-AE was the predominant subtype. Conclusion. The study identified a high prevalence of resistance to NNRTIs among HIV-1 infected infants less than 18 months of age in the Southern and Central Highland provinces of Vietnam. This highlights the need for further investigation and a potentially larger national survey to confirm the extent of this issue in Vietnam. Our findings support the current actions of the Vietnam Ministry of Health, which prioritize integrase inhibitor-based regimens as the preferred first line of ART for children to achieve durable viral suppression and minimize treatment failure. This approach aligns with the recommendations of the World Health Organization.