title: 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.
authors.affiliation: Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil Laboratory of Epidemiology Research and Social Determinants of Health, Instituto Nacional de Infectologia Evandro Chagas INI/IPEC-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Maria
authors.initials: M
authors.lastname: de Lourdes Teixeira
authors.affiliation: David Geffen School of Medicine at UCLA, Department of Pediatrics, Division of Infectious Diseases, University of California, Los Angeles, CA, USA.
authors.forename: Shamim
authors.initials: S
authors.lastname: Nafea
authors.affiliation: David Geffen School of Medicine at UCLA, Department of Pediatrics, Division of Infectious Diseases, University of California, Los Angeles, CA, USA.
authors.forename: Nava
authors.initials: N
authors.lastname: Yeganeh
authors.affiliation: Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.
authors.forename: Edwiges
authors.initials: E
authors.lastname: Santos
authors.affiliation: Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil Laboratory of Epidemiology Research and Social Determinants of Health, Instituto Nacional de Infectologia Evandro Chagas INI/IPEC-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Gouvea
authors.affiliation: Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.
authors.forename: Esau
authors.initials: E
authors.lastname: Joao
authors.affiliation: Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.
authors.forename: Loredana
authors.initials: L
authors.lastname: Ceci
authors.affiliation: Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.
authors.forename: Clarisse
authors.initials: C
authors.lastname: Bressan
authors.affiliation: Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.
authors.forename: Maria Leticia
authors.initials: ML
authors.lastname: Cruz
authors.affiliation: Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.
authors.forename: Leon Claude
authors.initials: LC
authors.lastname: Sidi
authors.affiliation: David Geffen School of Medicine at UCLA, Department of Pediatrics, Division of Infectious Diseases, University of California, Los Angeles, CA, USA knielsen@mednet.ucla.edu.
authors.forename: Karin
authors.initials: K
authors.lastname: Nielsen-Saines
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D005814:Genes, Viral / Q000235:genetics; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D016015:Logistic Models; D015999:Multivariate Analysis; D009154:Mutation; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000821:virology; D015995:Prevalence; D012367:RNA, Viral / Q000235:genetics*; D019562:Viral Load / Q000187:drug effects; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral
keywords: AIDS; HIV; PMTCT; antiretroviral resistance during pregnancy; antiretroviral therapy; prevention of mother to child transmission; treatment; vertical transmission of HIV; women