High rates of baseline antiretroviral resistance among HIV-infected pregnant women in an HIV referral centre in Rio de Janeiro, Brazil

Abstract

In order to understand antiretroviral resistance during pregnancy and its impact on HIV vertical transmission, we performed a cross-sectional analysis of 231 HIV-infected pregnant women who fulfilled Brazilian guidelines for antiretroviral testing and had antiretroviral genotypic testing performed between April 2010 and October 2012. At entry into prenatal care, the mean CD4 cell count for this cohort of patients was 406 cells/mm(3) (95% CI: 373-438 cells/mm(3)), while the mean HIV RNA was 24,394 copies/ml (95% CI: 18,275-30,513 copies/ml). Thirty-six women (16%) had detectable antiretroviral-resistant mutations. By 34 weeks gestation, 75% had achieved HIV RNA <400 copies/ml. Our logistic regression model showed the odds of harbouring antiretroviral-resistant virus with a baseline CD4 cell count of <200 cells/mm(3) was eight times that of subjects with CD4 cell counts >500 CD4 cells/mm(3) (95% CI 1.5-42.73). Six infants were HIV infected, four born to mothers with detectable viraemia at 34 weeks and two born to mothers who were lost to follow up. Antiretroviral resistance is common in prenatal care but did not increase vertical transmission if viral load was appropriately suppressed. Genotyping should be considered in Brazil in order to assist initiation of appropriate combination antiretroviral therapy during pregnancy to suppress viral load to avoid vertical transmission.

Human Immunodeficiency Virus Antiretroviral Resistance and Transmission in Mother-Infant Pairs Enrolled in a Large Perinatal Study

“…Our study's results reveal that DRMs can commonly affect HIVinfected individuals despite the lack of prior ARV exposure, with DRMs affecting >10% of treatment-naive pregnant women and their infants. In Brazil, a 10.4% rate of DRMs in pregnancy found in this study agrees with most other studies evaluating ARV drug resistance in pregnant women, with rates ranging from 9% to 13% [15][16][17]. More recent reports are showing a trend toward higher rates of DRMs in pregnant women in Rio de Janeiro, with a prevalence rate of 17.2% in treatment-naive patients [18].…”

Surveillance of HIV Transmitted Drug Resistance in Latin America and the Caribbean: A Systematic Review and Meta-Analysis

“…An exception is a small study in 24 pregnant women performed in 2009–2010 in Rio de Janeiro that showed no evidence of TDR [ 76 ]. Of note, the most recent survey in 231 pregnant women performed in 2010–2012 in Rio de Janeiro showed high-level TDR to any ARV drug [ 77 ].…”

Lower genetic variability of HIV-1 and antiretroviral drug resistance in pregnant women from the state of Pará, Brazil

“…The low prevalence of HIV-1 strains that are resistant to this class of drugs reflects the low circulation of viruses with resistance to PIs in the North region of the country [25], differently from what was observed in Rio de Janeiro [26] and in Goias [27] with a prevalence level around 16%.…”