Management of pregnancy in an HIV elite controller

Rutland, Emma; Mani, Reena

doi:10.1258/ijsa.2010.010153

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…In the literature we present a case of an HIV positive female elite control in Zimbabwe 15 weeks' gestation where zidovudine monotherapy was instituted following the guidance of the BHIVA guideline and was offered to the elective cesarean patient, with therapeutic success. Lactation was contraindicated [8]. …”

Section: Discussionmentioning

confidence: 99%

Pregnant HIV Elite Control: Therapeutic Conduct?

Agostini¹,

Sconochini²,

Maldacena³

et al. 2017

J AIDS Clin Res

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Physical examPatient lucido oriented in time and space. Preserved vital signs,no alterations are observed. Complementary methodsAnti-HIV serology on 3 samples, with two different enzyme-immunoassay techniques, Roche (rp=2320, 2220), Abbot (rp=587). Detectable proviral DNA. On a new sample, we repeat the viral load with ND result. We discard type 2 HIV infection using nucleic acid test for blood bank (Cobas Taqscreen MPX test, V2.0, Roche). Considering the possibility of mutations in the binding region of the primers of the quantification technique, we used a RT-PCR-NESTED protocol that amplifies protease and retro viral transcriptase, in which we did not obtain amplification product [2,3].On the other hand, we requested serology for HBV, HCV, Chagas, Toxoplasmosis and Syphilis, all negative.Given the incongruity in the studies performed, we contacted the parent company of Roche in the USA, where an investigation is initiated yielding the following result: sequencing of the gag region with positive result, the sequence corresponds to a Wild type virus, and sequencing of the negative LTR region. They conclude that this is a wild virus, with low or no viral load, which in the absence of treatment, corresponds to a case of HIV elite control. Antiretroviral therapy with zidovudine/lamivudine is started twice daily. The patient is monitored during the course of pregnancy; the ACTG 076 protocol is decided. The baby was born by vaginal delivery, with negative serology, is repeated at two months where it is again negative and again negative at three months. The baby was treated with zidovudine the first month of life [4]. DiscussionVertical transmission remains the main form of infection for more than 90% of children who acquire this infection. However, in pregnant women receiving antiretroviral therapy, this transmission decreased to below 2%. It can occur during pregnancy, during delivery or after delivery through breastfeeding [5,6].So far there is no guide with precise indications about handling in this situation. The ACTG 076 study demonstrated a 67% reduction in vertical transmission with zidovudine monotherapy [7].Regarding the time of the beginning of the treatment, both national and European guidelines recommend its establishment as soon as possible and no later than the second trimester [5,6]. In our case the patient was 20 weeks and the beginning was at the time of diagnosis.It was decided to start with the combination of zidovudine and lamivudine in order to reduce the risk of vertical transmission. In the literature we present a case of an HIV positive female elite control in Zimbabwe 15 weeks' gestation where zidovudine monotherapy was instituted following the guidance of the BHIVA guideline and was offered to the elective cesarean patient, with therapeutic success. Lactation was contraindicated [8]. AbstractHIV positive patients with sustained viral load <50 copies/mL are defined as elite controls in the absence of antiretroviral therapy and normal CD4+ values. The occurrence of this type of infections in...

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Section: Discussionmentioning

confidence: 99%

Pregnant HIV Elite Control: Therapeutic Conduct?

Agostini¹,

Sconochini²,

Maldacena³

et al. 2017

J AIDS Clin Res

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“…Data on the mode of delivery in elite controllers are sparse and limited to case reports . The benefits of PLCS at various levels of viraemia are discussed in Section 7.2: Mode of delivery.…”

Section: Use Of Antiretroviral Therapy In Pregnancymentioning

confidence: 99%

BritishHIVAssociation guidelines for the management ofHIVinfection in pregnant women 2012 (2014 interim review)

A¹,

Taylor²,

Clayden³

et al. 2014

HIV Medicine

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“…Data on the mode of delivery in elite controllers are sparse and limited to case reports [142]. The benefits of PLCS at various levels of viraemia are discussed in Section 7.2 (Mode of delivery).…”

Section: Grading: 1dmentioning

confidence: 99%

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2012

HIV Medicine

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Management of pregnancy in an HIV elite controller

Cited by 6 publications

References 11 publications

Pregnant HIV Elite Control: Therapeutic Conduct?

Pregnant HIV Elite Control: Therapeutic Conduct?

BritishHIVAssociation guidelines for the management ofHIVinfection in pregnant women 2012 (2014 interim review)

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