When prevention of mother-to-child HIV transmission fails: preventing pretreatment drug resistance in African children
The fact that children become HIV-infected despite the use of PMTCT (failing PMTCT) is not only problematic because these infections are preventable, but also because infection during antiretroviral exposure increases the risk of acquiring drug-resistant HIV variants. Consequently, despite a decrease in the overall numbers of vertical HIV infections, the proportion of children who become infected and bear drug-resistant virus early in life is very high (35–64%) in the region [8–10]. The plight of these children is dire with high risk of failure on a suboptimal standard first-line ART regimen, absence of resistance tests to inform drug choices and lack of alternative regimens in case of ART failure – all this in light of the need for lifelong effective therapy. In this opinion article, we provide arguments that increased efforts are needed to prevent HIV drug-resistance early in life in the context of ongoing PMTCT programs and limited ART options for children.