Drug resistance mutations jeopardise the success of antiretroviral therapy in children infected with the human immunodeficiency virus type 1 (HIV-1). We present the virologic and clinical outcomes of the Madrid cohort of perinatally HIV-infected children and adolescents after triple-class drug-resistant mutations were chosen (TCDRM). According to IAS-USA-2013, we assigned patients with HIV-1 variants with TC-DRM to nucleoside reverse transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors, and protease inhibitors. From 2000 to 2011, we recovered pol sequences or resistance profiles, as well as clinical-immunologic-virologic data from the time TC-DRM was detected until December 2013. From 2000 to 2011, viruses carrying TC-DRM were found in 48 (9%) of the 534 children and adolescents studied, rising to 24.4% among the 197 with resistance data. 95.8% of them were diagnosed before 2003. 91.7% were Spaniards, 89.6% had HIV-1 subtype B, and 75% had mono/dual therapy as their first regimen. D67NME, T215FVY, M41L, and K103N (retrotranscriptase) were the most common TC-DRMs found in 50% of them (protease). Darunavir, tipranavir, etravirine, and rilpivirine susceptibility rates were 67.7%, 43.7%, 33.3%, and 33.3%, respectively, and all reported high resistance to didanosine, abacavir, and nelfinavir. Despite the presence of HIV-1 resistance mutations to the three main antiretroviral families in our paediatric cohort, some drugs, primarily the new protease inhibitors and nonnucleoside reverse transcriptase inhibitors, retained their susceptibility. These findings will contribute to better clinical management of HIVinfected children with triple resistance in Seville (Dagum C et al.,1997).
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