title: Viral Suppression and Resistance in a Cohort of Perinatally-HIV Infected (PHIV+) Pregnant Women.
abstract: Our objective was to describe viral suppression and antiretroviral (ARV) resistance mutations in an ongoing cohort of perinatally-infected HIV+ (PHIV+) pregnant women. Descriptive analysis was performed using SPSS 18.0. From 2011 to 2014, we followed 22 PHIV+ pregnant women. Median age at prenatal entry was 19 years (Interquartile range (IQR) 17.6-21.0); 86% had an AIDS diagnosis; 81% had disclosed their HIV status to partner 11. The median age at HIV diagnosis was 8.3 y (IQR 4.0-13.6), the median age at sexual debut was 16 years (IQR 14-18). At the time of prenatal care initiation, four (18%) were on their first antiretroviral treatment (ART), eight (36%) in their second regimen and nine (41%) in their third regimen or beyond, and one had no data. Seventeen of 22 (77%) had HIV-viral load (VL) > 50 copies/mL at prenatal care entry, 16 had a genotyping exam performed. Seventeen of 22 PHIV+ had VL results near delivery: 7/17 (41%) had VL < 50 copies/mL. Among those who had genotyping at prenatal entry, 11/16 (69%) had mutations associated with ARV resistance. The most frequent major mutations were K103N, M184V, T215, M41L, D67N at reverse transcriptase gene and M46, I54V and V82A at protease gene. No vertical transmissions occurred. Management of pregnancy among PHIV+ is challenging. Individualized ART are needed to achieve viral suppression in a highly ART-exposed subpopulation.
authors.affiliation: Hospital Federal dos Servidores do Estado, Rio de Janeiro 20221-161, Brazil. mleticia@diphse.com.br.
authors.forename: Maria Letícia
authors.initials: ML
authors.lastname: Cruz
authors.affiliation: Hospital Federal dos Servidores do Estado, Rio de Janeiro 20221-161, Brazil. edwigesmotta@yahoo.com.br.
authors.forename: Edwiges
authors.initials: E
authors.lastname: Santos
authors.affiliation: Hospital Federal dos Servidores do Estado, Rio de Janeiro 20221-161, Brazil. mlbenamor@hotmail.com.
authors.forename: Maria de Lourdes
authors.initials: Mde L
authors.lastname: Benamor Teixeira
authors.affiliation: Hospital Federal dos Servidores do Estado, Rio de Janeiro 20221-161, Brazil. monipoletti@hotmail.com.
authors.forename: Monica
authors.initials: M
authors.lastname: Poletti
authors.affiliation: Hospital Federal dos Servidores do Estado, Rio de Janeiro 20221-161, Brazil. cacau.nandes@gmail.com.
authors.forename: Carolina
authors.initials: C
authors.lastname: Sousa
authors.affiliation: Hospital Federal dos Servidores do Estado, Rio de Janeiro 20221-161, Brazil. bebelsgouvea@uol.com.br.
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Gouvea
authors.affiliation: School of Medicine, David Geffen University of California, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA. KNielsen@mednet.ucla.edu.
authors.forename: Karin
authors.initials: K
authors.lastname: Nielsen-Saines
authors.affiliation: Hospital Federal dos Servidores do Estado, Rio de Janeiro 20221-161, Brazil. esaujoao@gmail.com.
authors.forename: Esaú
authors.initials: E
authors.lastname: João
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001938:Brazil; D015331:Cohort Studies; D060467:Disease Resistance / Q000235:genetics*; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009154:Mutation; D018743:Perinatal Care / Q000379:methods*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D019562:Viral Load / Q000187:drug effects*; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: HIV infection; drug resistance; mutation; pregnant women; vertical infection transmission