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ckly took up residence in inactive T cells, from where they could later launch an attack that NNRTIs could not stop. The news was not all bad: a different class of antiretroviral drugs, protease inhibitors (PIs), was effective in controlling HIV viral load and NNRTI-resistant virus strains for all infants studied.

These findings have important implications when it comes to choosing among available treatments. As Persaud summarized, "The initial transmitted drug-resistant virus will likely never be cleared from that infant with currently available treatments. However, it is important to point out that because PIs are the first-line drugs used to treat HIV infection in infants in the United States, PI-containing treatment was still effective in controlling the NNRTI-resistant virus in the infants in this study. As long as you do not use NNRTI-based treatment in these infants, you avoid applying pressure that allows drug-resistant HIV to flourish."

The study concluded that it is important to consider drug-resistance testing as a part of the initial evaluation of newly HIV-infected infants so that appropriate choices can be made when considering possible treatments, especially since PIs are not used worldwide as first-line therapy. Such testing must be paired with further studies on available and new therapies. As Persaud remarked, "It is important to fully understand the extent to which the persistent drug-resistant virus affects whether those drugs can be reused within the childs lifetime. This is a critical question and an area of intense investigation, especially in light of the high rates of antiretroviral drug resistance occurring in infants in low-income countries who received a single dose of an NNRTI for prevention of mother-to-child transmission, and for whom treatment options are few."

In an accompanying editorial, Paul A. Krogstad, MD, of the David Geffen School of Medicine at UCLA, noted that global elimination of pediatr
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Contact: Steve Baragona
sbaragona@idsociety.org
703-299-0412
Infectious Diseases Society of America
30-Apr-2007

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