title: [Viral failure in infants perinatally infected with HIV: A double punishment].
abstract: BACKGROUND
  Considering the remarkable efficacy of the strategies for preventing mother-to-child transmission of HIV infection (PMTCT), failures are rare in high-resource countries and deserve further investigation. Moreover, infants have been found to be at increased risk of viral failure. We analyzed the factors related to the children's environment, including maternal psychological factors that may be associated with viral failure in children diagnosed before the age of 1 year.
  
  
  METHODS
  Retrospective study of all HIV-infected infants, born in France between July 2003 and July 2013, diagnosed before the age of 1 year, cared for in a single reference center, comparing the group of children in viral success to the group of children presenting at least one episode of viral failure, using data available in their medical, psychological and social files.
  
  
  RESULTS
  Out of 1061 infants included in the prospective PMTCT follow-up, eight infants were found HIV-positive and an additional six cases were referred from other centers before the age of 1 year, for a total of 14 children born to 13 mothers. Seven children presented durable optimal viral control (VL<50 c/mL) whereas seven others did not reach or maintain optimal viral control over time. The main difference between the two groups was the presence among the mothers of children with viral failure of severe psychological disorders, leading to treatment adherence problems in the mothers who were aware of their HIV status before pregnancy, and difficulties in giving their children's treatments correctly.
  
  
  CONCLUSIONS
  Although seroconversion during pregnancy is responsible for a significant proportion of residual transmission in high-resource countries, severe psychological or psychiatric conditions in HIV-positive mothers play an important role on the risk of both MTC residual transmission and viral failure in their infants.
authors.affiliation: Service d'hématologie et oncologie pédiatrique, hôpital d'enfants A.-Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter-Paris, 72012 Paris, France. Electronic address: nadine.trocme@aphp.fr.
authors.forename: N
authors.initials: N
authors.lastname: Trocmé
authors.affiliation: Service d'hématologie et oncologie pédiatrique, hôpital d'enfants A.-Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter-Paris, 72012 Paris, France.
authors.forename: M-F
authors.initials: MF
authors.lastname: Courcoux
authors.affiliation: Service d'hématologie et oncologie pédiatrique, hôpital d'enfants A.-Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter-Paris, 72012 Paris, France.
authors.forename: M-D
authors.initials: MD
authors.lastname: Tabone
authors.affiliation: Unité de néonatologie, hôpital Tenon, AP-HP, 75020 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Hervé
authors.affiliation: Service de maternité, hôpital d'enfants A.-Trousseau, AP-HP, 75012 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Bui
authors.affiliation: Service de maternité, hôpital d'enfants A.-Trousseau, AP-HP, 75012 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Faucher
authors.affiliation: Service de maternité, hôpital Tenon, AP-HP, 75020 Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Selleret
authors.affiliation: Service de maladies infectieuses, hôpital Tenon, AP-HP, 75020 Paris, France.
authors.forename: M-G
authors.initials: MG
authors.lastname: Lebrette
authors.affiliation: Service d'hématologie et oncologie pédiatrique, hôpital d'enfants A.-Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter-Paris, 72012 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Leverger
authors.affiliation: Service d'hématologie et oncologie pédiatrique, hôpital d'enfants A.-Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter-Paris, 72012 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Dollfus
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology / Q000635:transmission*; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D009035:Mothers / Q000523:psychology; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D019380:Anti-HIV Agents