RESUMO
BACKGROUND: The aim of this study was to describe the frequency of minority populations of viruses carrying mutations K103N and M184V in drug-naive HIV type-1 (HIV-1)-infected children, and to further evaluate their effect on the selection of drug-resistant viruses within highly active antiretroviral therapy (HAART). METHODS: Newly diagnosed vertically HIV-1-infected children were evaluated. The HIV-1 pol gene was sequenced for subtyping and antiretroviral drug resistance analysis. Standard genotypic sequencing and sequence-selective real-time PCR (SPCR) to quantify minority viral populations were used. RESULTS: From December 2004 to July 2006, we included 35 children who were studied at baseline and during their first HAART regimen (follow-up median time 29.4 months). Of them, 82.9% were infected with intersubtype B/F recombinant variants. At baseline, all children had a drug-susceptible viral population that was studied by bulk sequencing. SPCR showed that 4 children had between 2-10% of M184V, 11 had <0.7%, 18 had no detectable mutation and 2 could not be amplified. No K103N minority populations were found. Once under HAART, children who had 2-10% of M184V at baseline further selected it in percentages >20% in less time than those with -0.1-0.6% or without minority populations (P=0.01). CONCLUSIONS: It was shown that having 2-10% of M184V at baseline enhanced its selection in high percentages in a short time after HAART initiation. Further research regarding the presence of minority quasispecies before initiation of HAART in large paediatric populations should be undertaken to evaluate their clinical effect during HAART.
Assuntos
Fármacos Anti-HIV/farmacologia , Farmacorresistência Viral/genética , Infecções por HIV/virologia , HIV-1/classificação , HIV-1/efeitos dos fármacos , Mutação , Adolescente , Terapia Antirretroviral de Alta Atividade , Argentina/epidemiologia , Criança , Pré-Escolar , Esquema de Medicação , Feminino , Genes pol , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , HIV-1/genética , HIV-1/isolamento & purificação , Humanos , Lactente , Estimativa de Kaplan-Meier , Lamivudina/farmacologia , Masculino , Nevirapina/farmacologia , Reação em Cadeia da Polimerase , Inibidores da Transcriptase Reversa/farmacologia , Seleção Genética , Análise de Sequência de DNARESUMO
Se presenta el caso de una recién nacida con tuberculosis. Las manifestaciones que motivaron la consulta fueron fiebre y rechazo del alimento. Se agregaron dificultad respiratoria, hepatoesplenomegalia, distensión abdominal (ascitis), plaquetopenia. La bibliografía sobre tuberculosis congénita y perinatal es una entidad que debe ser considerada entre los diagnósticos diferenciales del recién nacido infectado.