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Maternal Human Immunodeficiency Virus (HIV) Drug Resistance Is Associated With Vertical Transmission and Is Prevalent in Infected Infants.
Boyce, Ceejay L; Sils, Tatiana; Ko, Daisy; Wong-On-Wing, Annie; Beck, Ingrid A; Styrchak, Sheila M; DeMarrais, Patricia; Tierney, Camlin; Stranix-Chibanda, Lynda; Flynn, Patricia M; Taha, Taha E; Owor, Maxensia; Fowler, Mary Glenn; Frenkel, Lisa M.
Afiliación
  • Boyce CL; Department of Global Health, University of Washington, Seattle, Washington, USA.
  • Sils T; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA.
  • Ko D; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA.
  • Wong-On-Wing A; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA.
  • Beck IA; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA.
  • Styrchak SM; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA.
  • DeMarrais P; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA.
  • Tierney C; Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
  • Stranix-Chibanda L; Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
  • Flynn PM; University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
  • Taha TE; Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
  • Owor M; Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA.
  • Fowler MG; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda.
  • Frenkel LM; Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA.
Clin Infect Dis ; 74(11): 2001-2009, 2022 06 10.
Article en En | MEDLINE | ID: mdl-34467974
BACKGROUND: We aimed to assess if maternal human immunodeficiency virus (HIV) drug resistance is associated with an increased risk of HIV vertical transmission and to describe the dynamics of drug resistance in HIV-infected infants. METHODS: This was a case-control study of PROMISE study participants. "Cases" were mother-infant pairs with HIV vertical transmission during pregnancy or breastfeeding and "controls" were mother-infant pairs without transmission matched 1:3 by delivery date and clinical site. Genotypic HIV drug resistance analyses were performed on mothers' and their infants' plasma at or near the time of infant HIV diagnosis. Longitudinal analysis of genotypic resistance was assessed in available specimens from infants, from diagnosis and beyond, including antiretroviral therapy (ART) initiation and last study visits. RESULTS: Our analyses included 85 cases and 255 matched controls. Maternal HIV drug resistance, adjusted for plasma HIV RNA load at infant HIV diagnosis, enrollment CD4 count, and antepartum regimens, was not associated with in utero/peripartum HIV transmission. In contrast, both maternal plasma HIV RNA load and HIV drug resistance were independent risk factors associated with vertical transmission during breastfeeding. Furthermore, HIV drug resistance was selected across infected infants during infancy. CONCLUSIONS: Maternal HIV drug resistance and maternal viral load were independent risk factors for vertical transmission during breastfeeding, suggesting that nevirapine alone may be insufficient infant prophylaxis against drug-resistant variants in maternal breast milk. These findings support efforts to achieve suppression of HIV replication during pregnancy and suggest that breastfeeding infants may benefit from prophylaxis with a greater barrier to drug resistance than nevirapine alone.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Infecciosas del Embarazo / Infecciones por VIH / Fármacos Anti-VIH Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Female / Humans / Infant / Pregnancy Idioma: En Revista: Clin Infect Dis Asunto de la revista: DOENCAS TRANSMISSIVEIS Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Infecciosas del Embarazo / Infecciones por VIH / Fármacos Anti-VIH Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Female / Humans / Infant / Pregnancy Idioma: En Revista: Clin Infect Dis Asunto de la revista: DOENCAS TRANSMISSIVEIS Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos