HIV-1 mother-to-child transmission and drug resistance among Brazilian pregnant women with high access to diagnosis and prophylactic measures

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• 作者：Keila Correia Alcâ ; ntara^a ; Jana&iacute ; na Bacelar Accioli Lins^b ; Maly Albuquerque^b ; Let&iacute ; cia Mara Aires^b ; Ludimila Paula Vaz Cardoso^a ; Ana Lú ; cia Minuzzi^c ; Mariane Martins Araú ; jo Stefani^a ; ^{mariane.stefani@pq.cnpq.br}
• 关键词：HIV-1 ; human immunodeficiency virus type 1 ; MTCT ; mother-to-child transmission ; ARV ; antiretroviral ; PPPW ; Program for the Protection of Pregnant Women ; HAART ; highly active antiretroviral therapy ; NRTI ; nucleoside reverse-transcriptase inhibitors ; NNRTI
• 刊名：Journal of Clinical Virology
• 出版年：2012
• 期刊代码：150_13866532
• 类别：med
• 出版时间：May, 2012
• 卷：54
• 期：1
• 页码：15-20
• 文件大小：211 K

摘要

Background

A high-coverage public health prenatal program (70,000 women/year) from central western Brazil/Goias State has represented a unique opportunity for the early diagnosis of HIV-1 and implementation of strategies to prevent mother-to-child transmission (MTCT).

Objectives

To investigate MTCT among a prospective cohort of HIV-1 infected mothers/exposed infants.

Study design

142 mothers/their 149 infants (2008-2010) were investigated regarding maternal viral load, CD4⁺cell counts, HIV-1 pol sequences; infants鈥?HIV-1 RNA tests (30/120days), sequential anti-HIV-1/2 serology. HIV-1 subtypes were assigned by REGA. Transmitted drug resistance was identified by the Calibrated Population Resistance tool, secondary resistance by Stanford HIV-1 Drug Resistance/International AIDS Society databases.

Results

Mothers (median age = 24 years; 25/142 adolescents) were diagnosed during prenatal care (2008-2010) or previously (1994-2007). Recent cases were younger, mostly asymptomatic. Undetectable viremia and MTCT prophylaxis predominated in formerly diagnosed mothers. Recent cases had higher subtype C prevalence. One naive patient had transmitted resistance; ten antiretroviral-experienced patients had secondary resistance: 6 from MTCT prophylaxis, 4 under HAART. Late disclosure of diagnosis, vaginal delivery, breastfeeding, lack of oral zidovudine were observed in the three MTCT cases (3/149; 2.01%). Two of three infected infants harbored subtype C; infected infants/mothers did not have drug resistance mutations. Two of the transmitting-mothers had viremia <1000 copies/ml. Among exposed-uninfected infants the median time to seroreversion was 12 months.

Conclusions

In this study delayed disclosure of diagnosis, partial/no preventive measures, drug resistance among asymptomatic women under prophylaxis and MTCT in low viremic mothers raise concerns. The expansion of subtype C infection corroborates surveillance of HIV-1 diversity in this region.