[Factors associated with virological response in women receiving highly-active antiretroviral prophylaxis for HIV-1 mother-to-child transmission].
BACKGROUND
Pregnancy is the only circumstance in HIV infection requiring urgent virological response to the antiviral approach because of the influence of plasma viral load (VL) on mother-to-child transmission (MCT) of the disease. This study analyzes factors related to the time needed to reach VL < 400 copies/mL during antiretroviral prophylaxis for MCT.


METHODS
The study included a cohort of HIV-1 infected pregnant women enrolled between 2000 and 2005 with baseline CD4+ lymphocyte count > 300 cells/microL, highly-active antiretroviral prophylaxis for at least 4 weeks, antiretroviral interruption after delivery, and available laboratory data.


RESULTS
Seventy-five pregnancies were analyzed. Median baseline VL was 3.71 log(10) copies/mL and CD4+ count was 573 cells/microL. Prophylaxis started after 26.6 weeks of gestation and lasted up to 11.7 weeks in 75% of cases. The prophylactic regimen was changed in 12 pregnancies, 7 because of toxicity. A protease inhibitor was included in 33 prophylactic regimens, 11 of them with lopinavir. Prophylaxis resulted in undetectable HIV-1 VL within 6.7 weeks in 75% of pregnancies. VL was detectable at the end of prophylaxis in 5 cases. Time to undetectable VL was shorter if baseline VL was less than 100,000 copies/mL and the antiretroviral regimen was not changed during prophylaxis.


CONCLUSIONS
To achieve VL < 400 copies/mL at delivery, antiretroviral prophylaxis should be started before 26 to 28 weeks of pregnancy. A potent and well-tolerated prophylactic antiretroviral regimen will likely reduce the time to virological response. Trials investigating alternative regimens (e.g., lopinavir-containing) for patients with late diagnosis during prenatal care or VL >100,000 copies/mL are warranted.
Núcleo Multidisciplinar de Patologias Infecciosas na Gravidez, Disciplina de Infectologia, Universidade Federal de São Paulo, Brazil. ricardopalacios@gmx.net
Ricardo
R
Palacios
Jorge F
JF
Senise
Maria Josév R
MJ
Vaz
Adauto
A
Castelo
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission*; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D015497:HIV-1; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D061466:Lopinavir; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000188:drug therapy*; D011744:Pyrimidinones / Q000009:adverse effects / Q000627:therapeutic use; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D012306:Risk; D019562:Viral Load / Q000706:statistics & numerical data; D014766:Viremia / Q000188:drug therapy*
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D011744:Pyrimidinones; D018894:Reverse Transcriptase Inhibitors; D061466:Lopinavir
Factores asociados a respuesta virológica en mujeres que usaron profilaxis antirretroviral de gran actividad para transmisión materno-fetal del virus de la inmunodeficiencia humana tipo 1.