Background: The advent of resistance-associated mutations in HIV-1 is a barrier to the
success of the ARTs.
Objective: In this study, the abundance of HIV-1 infection in Iranian children, and also detection of
the TDR in naïve HIV-1 infected pediatric (under 12 years old) were evaluated.
Materials: From June 2014 to January 2019, a total of 544 consecutive treatment-naïve HIV-1-
infected individuals enrolled in this study. After RNA extraction, amplification, and sequencing of
the HIV-1 pol gene, the DRM and phylogenetic analysis were successfully performed on the plasma
specimens of the ART-naïve HIV-1-infected-children under 12 years old. The DRMs were recognized
using the Stanford HIV Drug Resistance Database.
Results: Out of the 544 evaluated treatment-naïve HIV-1-infected individuals, 15 (2.8%) cases were
children under 12 years old. The phylogenetic analyses of the amplified region of pol gene indicated
that all of the 15 HIV-1-infected pediatric patients were infected by CRF35_AD, and a total of
13.3% (2/15) of these children were infected with HIV-1 variants with SDRMs (one child harbored
two related SDRMs [D67N, V179F], and another child had three related SDRMs [M184V, T215F,
and K103N]), according to the last algorithm of the WHO. No PIs-related SDRMs were observed in
Conclusion: The current study demonstrated that a total of 13.3% of treatment-naïve HIV-1-infected
Iranian pediatrics (under 12 years old) were infected with HIV-1 variants with SDRMs. Therefore, it
seems that screening to recognize resistance-associated mutations before the initiation of ARTs
among Iranian children is essential for favorable medication efficacy and dependable prognosis.