Autor/a:
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Rupérez, María; Noguera Julian, Marc; González, Raquel; Maculuve, Sónia Amós; Bellido, Rocío; Vala, Anifa; Rodríguez, Cristina; Sevene, Esperança Júlia Pires; Paredes, Roger; Menéndez, Clara
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Abstract:
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BACKGROUND: Few data on HIV resistance in pregnancy are
available from Mozambique, one of the countries with the highest
HIV toll worldwide. Understanding the patterns of HIV drug
resistance in pregnant women might help in tailoring optimal
regimens for prevention of mother to child transmission of HIV
(pMTCT) and antenatal care. OBJECTIVES: To describe the
frequency and characteristics of HIV drug resistance mutations
(HIVDRM) in pregnant women with virological failure at delivery,
despite pMTCT or antiretroviral therapy (ART). METHODS: Samples
from HIV-infected pregnant women from a rural area in southern
Mozambique were analysed. Only women with HIV-1 RNA >400c/mL
at delivery were included in the analysis. HIVDRM were
determined using MiSeq(R) (detection threshold 1%) at the first
antenatal care (ANC) visit and at the time of delivery. RESULTS:
Ninety and 60 samples were available at the first ANC visit and
delivery, respectively. At first ANC, 97% of the women had HIV-1
RNA>400c/mL, 39% had CD4+ counts <350 c/mm3 and 30% were
previously not on ART. Thirteen women (14%) had at least one
HIVDRM of whom 70% were not on previous ART. Eight women (13%)
had at least one HIVDRM at delivery. Out of 37 women with data
available from the two time points, 8 (21%) developed at least
one new HIVDRM during pMTCT or ART. Twenty seven per cent
(53/191), 32% (44/138) and 100% (5/5) of the mutations that were
present at enrolment, delivery and that emerged during
pregnancy, respectively, were minority mutations (frequency
<20%). CONCLUSIONS: Even with ultrasensitive HIV-1
genotyping, less than 20% of women with detectable viremia at
delivery had HIVDRM before initiating pMTCT or ART. This
suggests that factors other than pre-existing resistance, such
as lack of adherence or interruptions of the ANC chain, are also
relevant to explain lack of virological suppression at the time
of delivery in women receiving antiretrovirals drugs during
pregnancy. |