Article (Scientific journals)
Resistance testing in children changing human immunodeficiency virus type 1 protease inhibitor
Servais, Jean; Hainaut, M.; Schmitz, V. et al.
2002In Pediatric Infectious Disease Journal, 21 (3), p. 214-220
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Keywords :
human immunodeficiency virus type 1-infected; children; protease inhibitor resistance; nelfinavir; highly active antiretroviral therapy; cross-resistance
Abstract :
[en] Objective. To assess genotypic and phenotypic resistance testing in HIV-1-infected children failing a first protease inhibitor (PI) therapy. Methods. In a multicenter observational study 21 children, ages 3 to 16 years, were given two reverse transcriptase inhibitors and one PI (mainly ritonavir, n = 18). They were subsequently treated with single or dual PI-based therapy (predominantly nelfinavir, n = 10, or ritonavir-saquinavir, n = 7). Resistance testing was performed at the time of therapy switch via direct sequencing and a recombinant virus susceptibility assay. Results. A total of 21 genotypic and 15 phenotypic resistance profiles were obtained. Most viruses displayed several reverse transcriptase mutations; however, 7 isolates maintained a wild-type protease. Ritonavir targeted the well-known pathway containing 82, 54, 46 and other secondary (nonactive site) mutations including T74A. No in vitro cross-resistance, i.e. greater than or equal to8-fold resistance to saquinavir or amprenavir, was encountered. Secondary mutations enhanced the prediction of ritonavir resistance (i.e. L10I) and in vitro nelfinavir cross-resistance (i.e. K20R/I conferred by primary (active site) resistance mutations. Either the 82, 54, 46 mutational genotype or the phenotype showing greater than or equal to8-fold nelfinavir cross-resistance predicted a poorer virologic response to nelfinavir salvage therapy. Conclusion. In a small cohort of heavily pretreated pediatric patients, resistance testing appears to predict the response to nelfinavir as salvage for a ritonavir-based therapy. This is further supported by the correlation between ritonavir-selected mutations and in vitro nelfinavir cross-resistance. Prospective studies should assess clinical outcome in children undergoing regimen changes based on resistance testing.
Disciplines :
Immunology & infectious disease
Author, co-author :
Servais, Jean
Hainaut, M.
Schmitz, V.
Maes, P.
Fransen, E.
Vaira, Dolorès ;  Centre Hospitalier Universitaire de Liège - CHU > Immuno-hématologie
Brichard, B.
Arendt, V.
Schneider, F.
Hemmer, R.
Schmit, J. C.
Language :
Title :
Resistance testing in children changing human immunodeficiency virus type 1 protease inhibitor
Publication date :
March 2002
Journal title :
Pediatric Infectious Disease Journal
Publisher :
Lippincott Williams & Wilkins, Philadelphia, United States - Pennsylvania
Volume :
Issue :
Pages :
Peer reviewed :
Peer Reviewed verified by ORBi
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