Resistance rates among antiretroviral regimens in pregnant people living with HIV

Abstract

ObjectivesTo update nucleoside reverse transcriptase inhibitor (NRTI), nonnucleoside reverse transcriptase inhibitor (NNRTI) and protease inhibitor (PI) resistance rates and describe the frequency of HIV subtypes in a cohort of pregnant people living with HIV (PPLH) at a national Prevention of Mother‐To‐Child HIV Transmission (PMTCT) centre.MethodsWe evaluated genotypic resistance among PPLH during prenatal care who were antiretroviral therapy‐naïve or experienced. We determined mutations by the Surveillance of Drug Resistance Mutations (SDRM) dataset and also focused on studying participants with intermediate or high resistance defined through the Stanford score.ResultsFrom 2018 to 2021, 1170 PPLH received prenatal care at the centre and 550 were genotyped. Among the 295 SDRMs, with respect to NRTI resistance mutations, there were 27/295 (9.2%) M184V/I, 14/295 (4.7%) T215Y/C/D/E/F/V/I/S and 12/295 (4.1%) M41L. For NNRTI, there were 75/295 (25.4%) K103N, 18/295 (6.1%) M230L and 14/295 (4.7%) G190A/E/S mutations. For PI, the most frequent mutations were 13/295 (4.4%) V82A/S/F/T, 12/295 (4.1%) M46I/L and 10/295 (3.4%) D30N. Based on the Stanford score, 36/224 (16%) naïve participants had one or more antiretroviral resistance mutations, 81% of whom had NNRTI resistance. In the treatment‐experience group, 108/326 (33%) had one or more mutations, 91% of whom had NNRTI resistance. The most frequent HIV subtype was B (82.5%).ConclusionsOur findings suggest that continuous surveys of HIV genotype appear to be important tools to map the distribution and evolution of HIV subtypes and resistance to provide information to support treatment policies. Furthermore, concerns about the use of rilpivirine‐containing regimens underscore the importance of resistance surveillance.

Growth of infants delivered by mothers with HIV in Guangxi, China: An 18‐month longitudinal follow‐up study, 2015–2021

“…In the absence of interventions, mother-to-child transmission of HIV ranges from 15% to 45%; in the non-breastfeeding population, this rate can be reduced to <2% with effective interventions during pregnancy and childbirth [12]. Despite the global success of PMTCT, some pregnant women with HIV are not diagnosed until the third trimester or even during childbirth, and so do not receive effective PMTCT interventions [13,14]. Hence, the growth and development of infants born to mothers with HIV and the genetic subtypes and drug resistance of infants with HIV deserves attention.…”