# HIV drug resistance amongst children and adolescents with viraemia in Lesotho and Tanzania: a nested analysis in the GIVE MOVE trial

## TL;DR

This study examines drug resistance in children and adolescents with HIV in Lesotho and Tanzania, finding that most had active treatment regimens despite ongoing virus in their blood.

## Contribution

The study provides new insights into drug resistance patterns and regimen effectiveness in pediatric and adolescent HIV patients in sub-Saharan Africa.

## Key findings

- Over half of participants had ART regimens predicted to be fully active despite viraemia.
- 12% of participants had resistance against their ART core agent, including one with high-level dolutegravir resistance.
- Most resistance mutations were against non-nucleoside and nucleoside reverse transcriptase inhibitors.

## Abstract

Children and adolescents with HIV have lower treatment success than adults. Suboptimal adherence and resistance to antiretroviral therapy (ART) are known aetiological factors. This preplanned analysis in the GIVE MOVE trial (NCT04233242) describes drug resistance patterns in children and adolescents in Lesotho and Tanzania.

GIVE MOVE randomized children and adolescents (6 months to below 19 years) with recent viraemia whilst taking ART to genotypic resistance testing (GRT)-informed care or usual care. Here, we conducted additional post-hoc GRT on stored samples from both groups and included participants with at least one successful resistance test. We assessed the number of drugs predicted to be active in participants’ three-drug ART regimens and resistance-associated mutations.

Amongst 137 participants, the majority were female (58%) and lived in Lesotho (77%). At their initial GRT, 69/137 (50%) were receiving protease inhibitor-based, 59/137 (43%) dolutegravir-based and 9/137 (7%) efavirenz-based ART. At that time, 80/137 (58%) participants had three, whilst 8/137 (6%) had two, 36/137 (26%) had one and 13/137 (9%) had no drugs predicted to be active in their regimens. Seventeen (12%) participants had resistance against their ART core agent, including one with high-level dolutegravir resistance.

Across 312 detected resistance-associated mutations (222 major, 90 accessory), 146 conferred resistance to non-nucleoside reverse transcriptase inhibitors, 127 to nucleoside reverse transcriptase inhibitors, 28 to protease inhibitors and 11 to integrase strand transfer inhibitors.

Given that more than half had an ART regimen predicted to be fully active, most viraemia in children and adolescents could not be explained by resistance.

Registration: The GIVE MOVE trial was registered on Clinicaltrials.gov NCT04233242