title: Incident and long-term HIV-1 infection among pregnant women in Brazil: Transmitted drug resistance and mother-to-child transmission.
abstract: Primary infection, seroconversion, and transmitted drug resistance (TDR) during pregnancy may influence the risk of mother-to-child-transmission (MTCT) of HIV-1 infection. This study estimated recent seroconversion, TDR rates, HIV-1 subtypes and pregnancy outcomes among 95 recently diagnosed, antiretroviral (ARV)-naïve pregnant women recruited during antenatal care in central western Brazil. Recent seroconversion was defined by BED-capture enzyme immunoassay (<155 days) and ambiguous nucleotides base calls (<1 year) in pol sequences (protease-PR and reverse transcriptase-RT regions). TDR was evaluated by the Calibrated Population Resistance tool. HIV-1 subtypes were defined by REGA and phylogenetic analyses. The median age of participants was 25 years; the median gestational age at diagnosis was 20.5 weeks. Based on serology and sequence polymorphism, recent infection was identified in 11.6% (11/95) and, 9 of them (82%), probably seroconverted during pregnancy; one MTCT case was observed among them. Three cases of stillbirth were observed among chronic infected patients (3.6%; 3/84). Moderate rate of TDR was observed (9/90, 10%, CI95% 4.7-18.1%). Subtype B was 60% (54/90), 13.3% (12/90) was subtype C, 6.7% (6/90) was subtype F1. Recombinant B(PR) /F1(RT) and F1(PR) /B(RT) viruses comprised 15.5% (14/90); B(PR) /C(RT) mosaics represented 4.4% (4/90). Seroconversion during pregnancy, late presentation to antenatal care and moderate TDR identified in this study represent significant challenges for the MTCT elimination. J. Med. Virol. 88:1936-1943, 2016. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Goiás, Brazil.
authors.forename: Yanna Andressa Ramos
authors.initials: YA
authors.lastname: Lima
authors.affiliation: Department of Medicine, Federal University of Goiás, Jataí, Goiás, Brazil.
authors.forename: Ludimila Paula Vaz
authors.initials: LP
authors.lastname: Cardoso
authors.affiliation: Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Goiás, Brazil.
authors.forename: Mônica Nogueira da Guarda
authors.initials: MN
authors.lastname: Reis
authors.affiliation: Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Goiás, Brazil.
authors.forename: Mariane Martins Araújo
authors.initials: MM
authors.lastname: Stefani
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D024882:Drug Resistance, Viral; D005260:Female; D014644:Genetic Variation; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission* / Q000821:virology*; D054303:HIV Reverse Transcriptase / Q000235:genetics; D006679:HIV Seropositivity; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D009035:Mothers; D020125:Mutation, Missense; D010802:Phylogeny; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000821:virology*; D011256:Pregnancy Outcome; D017422:Sequence Analysis, DNA; D050497:Stillbirth / Q000453:epidemiology; D054302:pol Gene Products, Human Immunodeficiency Virus / Q000235:genetics
chemical_list: D019380:Anti-HIV Agents; D054302:pol Gene Products, Human Immunodeficiency Virus; D054303:HIV Reverse Transcriptase
keywords: HIV-1; drug resistance; pregnancy; seroconversion